What is Somatic Psychotherapy
Severe stress can be man-made or event-made: it can come from long-standing relationships with traumatic figures in our life, or it can come from specific events. It can result from accidents, invasive medical procedures, war, natural disasters, sexual or physical assault, birth trauma, emotional abuse, loss, neglect, and the long-term corrosive effects of cumulative fear and conflict. What is traumatic is not measured by the magnitude of the event but by the effect that the event has on us.
When something bad happens to us we experience it in our thoughts, with our emotions, we experience in our movements and actions, in the meaning we assign to the event and to the people in it, and of particular importance we experience the bad feeling physically in our body. Some of the ways we feel it in our body we are aware of (and those get remembered in what's called explicit memories) and some of the ways we feel it in our body are out of our awareness (and those get remembered in what's called implicit memories). The fallout from an unpleasant event can take the physical form of headaches, body aches, muscle tension, physical fatigue, sleeplessness, appetite suppression, confusion, lethargy, and it can take the form of irritated organs like the bowel or the stomach or the lungs or the heart, which may manifest as irritable bowel syndrome, acid reflux, stomach cramps, shortness of breath, heart palpitations, and so on. It can also take on more subtle somatic forms, where we detach from our body and not know how we are feeling--where we may withdraw from our own experience or feel numb inside or believe we are not having any emotion. This pattern often manifests in so-called depressive feelings or when feelings build until a breaking point, where they can impulsively emerge in a flood of emotion.
While cognitive-behavioral psychotherapy focuses on the impact our thoughts are having on our symptoms and depth oriented psychotherapies like psychoanalytic psychotherapy focus on the meaning we assign to the event or to the symptoms themselves, somatic psychotherapy focuses on how the body may be trying to adapt to the painful event and on what the body may be trying to tell us about how it needs to heal from the event.
To understand what somatic psychotherapy is and how it differs from other forms of psychotherapy, let's begin with what may seem like a simple question: What is an emotion? With but a few notable exceptions, mainstream psychological science has considered an emotion to be an aspect of human functioning that is organized and housed within the confines of the brain. Over the last 25 years, though, from various pursuits within modern neuroscience, the ever-emerging finding has been that an emotion is an elaborate physiological process taking place not only in the brain but throughout the brain-body complex. For example, research by neuroscientist Antonio Damasio (1994) has found when the brain is observed through scans or other measures that emotions are so integrally linked to thoughts and actions that they are not readily distinguishable from one another.
The old neuroscience concluded that the brain localizes different functions in separate anatomic parts of itself--for example, that emotions are localized within the limbic system, that thoughts are localized in the prefrontal cortex. The newest neuroscience research, however, has shown that thoughts and feelings can emerge from many parts of the brain simultaneously. To take another example, it was generally believed throughout the field of psychology that a highly stimulating event triggers feelings and physiological reactions that occur simultaneously but are completely independent of one another. Another older theory that for decades was widely accepted within the field was that emotional reactions were the product of physical arousal combined with the thought-labels we assign to the arousal. The newer researcher in the field of embodied cognition, however, has shown that emotions themselves can occur in sequences that precede, not follow, the presence of a thought. And research by leading neuroscientist Candace Pert (1999) has shown that what we call emotions are changes in peptide levels that are occurring throughout the brain-body complex.
So then, what is an emotion? It's a complex set of physiological processes that we label with terms that summarize that experience. As neuroscientist Lisa Feldman Barrett (2017) illustrates, emotions are how our body is reacting to ambiguous data from our own body and from the environment. She writes, "What is that rectangular source of light with changing patterns of color? A window!" or "What is this intermittent pattern of small, cold spots sweeping across my body? Rain!" Just like the beauty of a exquisite work of pointillism can only be appreciated from a distance or the clarity of a digital image can only be achieved by avoiding getting lost in each pixel comprising it, so too can we understand emotion as a composite of physiological changes occurring at a cellular and molecular level within the brain-body.
With the understanding that anger or fear or shame or sadness are emotions we experience in the whole of our body, we can begin to appreciate that healing the wounds from having been overwhelmed by our feelings requires paying attention to the brain-body, what it needs, what it is trying to express, and what it might be telling us to help it heal. This is the essence of somatic psychotherapy, and there are several broadly recognized and widely respected curriculum that organize the tremendous amount of knowledge and research on the relationship between the body, emotions, thoughts, actions, and healing. I have been trained in two of them: a) Somatic Experiencing and b) Integral Somatic Psychology.
What is Somatic Experiencing
"The Somatic Experiencing® method is a body-oriented approach to the healing of trauma and other stress disorders. It is the life’s work of Dr. Peter A. Levine, resulting from his multidisciplinary study of stress physiology, psychology, ethology, biology, neuroscience, indigenous healing practices, and medical biophysics, together with over 45 years of successful clinical application. The SE approach releases traumatic shock, which is key to transforming PTSD and the wounds of emotional and early developmental attachment trauma."
~The Trauma Healing Institute
Somatic Experiencing is a therapeutic method that focuses on a person's innate but under-discovered capacity to regulate the way their own nervous system responds to stress. Although there are a variety of other body-based methods to calm the nervous system--e.g., relaxation methods, mindfulness meditation, yoga, diaphragmatic breathing--the Somatic Experiencing method focuses on the specific ways a client is storing the tension in their body.
Again, unlike cognitive-behavioral methods that focus on changing irrational thoughts or psychodynamic methods that focus on the cathartic release of repressed feelings, Somatic Experiencing pays particular attention to the physical correlates of stressful experiences. This method is especially useful for people who may not know why they are anxious, or why they are depressed, or why they may be reclusive, or why they may be acting out in problematic ways. As trauma expert Bessel van der Kolk, MD has said, "It is the body that keeps the score."
In healthy adults, our memory is not fixed around past events--our memory of the past automatically updates as we get new information and places those events in better context. This automatic updating allows us to adapt, to grow, to evolve, and to learn how to better adjust to similar experiences that may arise. However, in traumatic memory or the remembering of stressful events, those memories can become frozen, stuck, and unable to reorganize themselves around new information. Traumatic memories are stored at several different levels:
1) as recollections of what we saw, heard, smelled, tasted, or touched when we were there, and if those images aren't available we form internal representations of those external events,
2) as remembrances of how we felt,
3) as vocal patterns and as voluntary and involuntary patterns of movement—e.g., posture, facial expressions, patterns of breath, motor tics, etc.,
4) as meanings or interpretations we have made of the experience, and
5) as emphasized in Somatic Experiencing, as physical sensations we store in our body.
In Somatic Experiencing, these physical sensations are referred to as our "felt sense." We often don't know how or why we know we are uncomfortable--we might not have an emotional label for it--we just have a felt sense that we don't feel good.
Somatic Experiencing addresses this "felt sense," the details of which quite often may be outside of our awareness and identification. It may manifest in unconscious rocking or fidgetiness or fatigue or withdrawal. However, to the trained clinician and eventually to the client as well, the physical manifestation of traumatic stress is palpable, it can be observed, and it can be tamed and slowly released. What we are aware of related to our own stress is just the tip of the memory iceberg. Our deepest wounds are held in physical memories, like how we braced or fought or fled or froze or recoiled or shrunk in the face of our traumas.
Whenever we are threatened our body goes through a rapid sequence of automatic responses that are hard-wired into our nervous system:
1) movement stops
2) we orient ourselves to the environment and begin scanning it
3) we evaluate whether it's safe or dangerous
4) we initiate protective responses, if needed, like flight, fight, freeze, or reaching out to others, and
5) when the danger has passed we discharge our excessive energy and begin to settle back down.
With traumatic memories, however, we become stuck somewhere in this sequence and fail to complete it. Our traumatic memories literally become disembodied parts of our experience and unavailable to heal. Somatic Experiencing is a method that addresses this lack of completion and allows our healing to occur.
Somatic Experiencing References
Levine, P. A. (2015). Trauma and memory: Brain and body in a search for the living past. Berkeley, CA: North Atlantic Books.
Levine P. A. (2010). In an unspoken voice: How the body releases trauma and restores goodness. Berkeley, CA: North Atlantic Books.
Levine, P. A., & Kline, M. (2008). Trauma-proofing your kids: A parents' guide for instilling joy and resilience. Berkeley, CA: North Atlantic Books.
Levine, P. A., & Kline, M. (2008). Trauma through a child's eyes: Awakening the ordinary miracle of healing. Berkeley, CA: North Atlantic Books.
Levine P. A. (1997). Waking the tiger: Healing trauma. Berkeley, CA: North Atlantic Books.
What is Integral Somatic Psychology
Integral Somatic Psychology (or ISP), developed by Raja Selvam (e.g., 2018)., is another type of somatic psychotherapy that like Somatic Experiencing theorizes that stored traumatic experiences are complex psychological and physiological processes that are remembered not simply as thoughts or images in our brain but that also exist in an enduring relationship with our physical body. All somatic psychotherapies recognize that a person's ability to tolerate an unpleasant experience will depend on the emotional support they have from others in their present life and from those who have supported them in the past. They also acknowledge in one form or another that the person's attitude about emotions--that is, how they view the role of emotions in living a healthy and fulfilling life--will also be essential to their recovery from an unpleasant experience. What distinguishes ISP from other somatic psychotherapies is that ISP focuses on the embodiment of the unpleasant emotions associated with the experience.
To embody an emotion is to fully experience that emotion throughout as much of the body as possible and by doing so--especially with painful emotions--build greater capacity to better tolerate that emotion for longer periods of time. In essence, ISP helps us learn how to build a bigger and stronger container to hold unpleasant emotions, thereby enhancing our ability to live with them despite them being unpleasant.
Studies of the embodiment of emotions have shown that when it comes to unpleasant emotions we do not experience them throughout our body but instead shunt that experience in one or more major regions of our body.
Here's a metaphor ISP uses to explain why embodiment of emotions is essential: it's easier to carry a 20 pound bag with two hands than it is with one--that is, by distributing and dispersing the emotion over more of our body the unpleasant emotion becomes less concentrated and therefore less impactful on our body's capacity to naturally regulate itself.
Strong emotions from events that have overwhelmed us cannot be understood or made sense of unless they are first made tolerable. And our memory of events that have consumed us in some way can be tolerated only after the emotions associated with those events are tamed. We don't want to rid ourselves entirely of unpleasant emotions. Painful emotions alert us that something isn't right--painful emotions are necessary for our survival. We want to learn from the unpleasantness--learn to master it--so we can use it in ways to empower us and enhance our lives. Then, when unpleasantness arises we can act on them more effectively, give ourselves more choices, and take better care of our enlightened self-interests and those of others.
When we experience a painful emotion our body automatically reacts to the pain in two principal ways: 1) it tries to brace against it or 2) it tries to shut it down. Neither works very well, but hey, it's painful. Why would we want to feel it? So we deny; we ignore; we compartmentalize the feeling in one part of our body or another. In the short run, this can be functionally adaptive in that the painful feeling is only affecting one part of the body and not the rest. This turns out to be a good enough short-term strategy to keep us going but a very poor long term strategy. ISP uses our understanding of how each layer of the body--joints, muscles, organs, the nervous system--can generate or defend against emotion (by bracing or by shutting down) and how the emotion in these layers can be accessed and better embodied through self-touch, movement, breath, awareness, visualization, vocalization, and intention.
When we have been through something terrifying, something tragic, something humiliating, or something enraging, our usual ways of coping may not work. ISP can help a person work with their body to better regulate and soften the painful feelings it has experienced so that when the painful feeling is remembered it is recalled in a way that overwhelms less often, with less intensity, and for shorter periods of time.
Integral Somatic Psychology References
Barrett, L. F. (2017). How emotions are made: The secret life of the brain. Houghton Mifflin Harcourt: Boston and New York.
Damasio, A. (2003). Looking for Spinoza: Joy, sorrow, and the feeling brain. New York: Harcourt.
Nummenmaa, L., Glerean, E., Hari, R., & Hietanen, J. K. (2014, January 14). Bodily maps of emotions. Proceedings of the National Academy of Sciences of the United States of America, 111, 646-651; https://doi.org/10.1073/pnas.1321664111
Pert, C. (1999). Molecules of emotion: The science behind mind-body medicine. New York: Simon & Schuster, Inc.
Selvam, R. (2018, February 28). The science of embodied cognition and enactive emotion: Implications for improving outcomes in all therapies. Integral Somatic Psychology.
To learn more about Integral Somatic Psychology, visit IntegralSomaticPsychology.com.