What happens in a somatic experiencing session?

First things first. What is somatic experiencing?! 

I have written several articles which attend to this very question, so I will be brief here. Somatic experiencing (SE) is a unique therapeutic approach to trauma that directly addresses nervous system dysregulation and focuses on the internal capacity for regulation and the in-built resiliency of the body. It is a holistic approach to the treatment of trauma with an emphasis on interoceptive awareness; the awareness of the visceral sensations of the body.

Where cognitive therapies (top-down) focus on how thinking and processing of information influences our internal regulatory system, somatic experiencing (bottom-up) attends to the regulation or dysregulation of the nervous system in the body and how this affects our cognitive processes. By working with the awareness of these visceral sensations symptoms of traumatic stress can be resolved. Furthermore, many studies consistently show a lasting reduction of symptoms, and complete healing, of PTSD.

So what happens during a session?

For those who have attended talking therapies before, you’ll be aware that you might sit opposite your therapist, a few meters away and be invited to talk through any issues that you may be having. The therapist may offer insights, a different perspective or challenge unhealthy thinking.

It is a very collaborative space that is designed to help you better understand yourself and your reactions/responses to events in your life. When SE is added to a psychotherapeutic approach simply adds another dimension to the therapy. 

In the first session, you may be introduced to how your therapist works, as we all work slightly differently and integrate our modalities in different ways. In the first session with me, I would explain the importance of attending both to the mind and the body. A short tour of the nervous system and nervous system responses would follow because it’s important to understand what is happening inside your body when you experience a stress response to past trauma. In many ways, it takes the fear and shame out of the process if you start to realise that these reactions are biological responses that are currently out of your direct control.

So how would this look in practice?

As we start to add body awareness to the sessions, you may be asked to shift your attention momentarily to the sensations in your body. Perhaps you notice a tightness in your chest and that your breathing is getting a little more laboured.

Asking you, at this point, to make sense of your somatic reaction will engage the cognitive part of your brain where long-held defensive and adaptive strategies may keep you from fully resolving issues. Instead, we may stay with the sensation of the tightness of the chest to see how it feels when you do. Most often, giving the body the gift of your attention will help start to regulate the nervous system and I would guide you in how to track it as it down-regulates.

You may then start to feel the tightness ease and as we follow those sensations you may become away that your shoulders drop a little and your heart rate starts to normalise. On occasion, placing awareness on the area may intensify it and this too is important information. In these cases, I may invite you to draw your attention to a part of your body that feels less intense or relatively relaxed. This sends signals to the rest of the nervous system that it can begin to stand down from alert.

As we move from awareness of stress to awareness of calm, the body starts to unravel the stuckness that is a hallmark of PTSD. Over time, this may allow images or emotions to start to come to the surface, beginning the process of trauma resolution. 

Do we talk at all?

Some clients will come to somatic experiencing sessions when they are not ready to tell the story of what happened to them. This is fine. There is a lot of work that we can do without having to go into any details about a traumatic event. As your mind takes you back so your body will follow and an SE therapist is able to help guide you in managing those sensations and bringing resolution and regulation back to the nervous system without any details of what happened to you. 

Other clients feel that their story needs to be told and find that going into the body interrupts this flow. While it can feel irritating at first, slowing the story down and attending to your body is a core tenet of SE therapy as it counters the experience of the trauma itself.

An SE therapist wants to hear your whole story but that includes the story that the body has to tell. As I’ve mentioned previously the mind may have some well-honed defences that kept you safe at the time of the trauma but are now hindering your healing. An example of this may be that you tell a part of your story with a surprising amount of ease but your body is stiff and your face begins to flush. The truth about how you feel is in the body while cognitively the mind is putting on a good show that you may not even be aware of anymore. Acknowledging your somatic responses allows the body to begin to resolve what has been stuck, even if it’s been many decades. 

Somatic experiencing attends to both body and mind. In a simplified form, we can think of the brain as having three distinct parts. Cognitive reasoning, emotional and instinctual. Gaining access to these parts of the brain is not a case of just talking at them. The language of the cognitive reasoning part of the brain is curiosity, intellect, understanding and meaning-making.

To access the emotional part of the brain we need to use softer language and empathic responses. When it comes to the instinctual part of the brain, the language we use is sensation. This is because the instinctual part of the brain does not think or reason; it reacts. It is the only part of the brain that is online at the time of trauma and the other parts of the brain become involved over time to try and help you make sense of what happened, often unsuccessfully. It would stand to reason then, that helping the body to resolve the instinctual reactions should come first and then the rest will follow. That would be the preference, but it’s not always possible.

What happens if you're too scared to see what's held in the body?

This is an important question. Some clients find sensing the body very difficult, and sometimes quite frightening. It’s important then to have these other channels available to us when the body is not yet ready to be accessed in this way. In these cases, we can emphasise the cognitive parts of the story or start to draw attention to your behaviours. Perhaps you rock back and forth or tap your foot on the floor when you think about something stressful. There are many ways to help bring the internal sensing systems online where we can then start to work on what comes from that.

One of the central tenets of somatic experiencing is to give the client a different experience from that of their trauma. Trauma is too much, too fast or too soon. Practitioners are well aware of this and are able to watch for signs that the nervous system is starting to get overwhelmed. At this point, we will always have a way (that we will have practised together in our first session) to help regulate the system and bring you back into the present moment. This is not exposure therapy and somatic experiencing practitioners have no desire to re-traumatise or overwhelm you as this is counter to the aim of the therapy.