Somatic Therapy: How It Works and What to Expect

What Is Somatic Therapy?

Somatic therapy focuses on connecting the mind and body to heal mental health ailments and increase wellness. Somatic therapy includes interventions such as grounding, boundary development, movement and process, titration, and self-regulation as well as complementary and alternative movement modalities such as tai chi, therapeutic touch, massage, and yoga.^{1,2,3,4,5,6,7} This body-centered approach trains people to be more in tune with the physical sensations that manifest as a result of mental health struggles.

Somatic therapy combines psychotherapy techniques such as experiential exploration, talk therapy, dream work, interpretation, and reflection, while integrating interoceptive, kinesthetic, and proprioceptive experience as part of the psyche.^5,6 Becoming more mindful of physical sensations assists in the healing process by engaging the reticular arousal systems (RAS), the autonomic nervous system (ANS), the limbic system, and the emotional motor system (EMS).⁶

How Is Somatic Therapy Different From Talk Therapy?

Somatic therapy differs from talk therapy in a few important ways. While talk therapy analyzes thoughts, behaviors, and emotions, somatic therapy focuses on the body’s role in processing emotions and experiences. Talk therapy is often described as a “top-down” approach, where raising cognitive awareness of behavioral and emotional patterns can incite change, whereas somatic therapy is described as a “bottom-up” approach in which patterns are changed through the body’s movements.⁸

Are Somatic Techniques Incorporated Into Talk Therapy?

Oftentimes talk therapy is utilized in conjunction with somatic therapy, though it plays a supporting role. The therapist might process the somatic intervention with the client before the end of the session, or check-in with them before getting started to learn about any developments in the person’s life. Somatic grounding and mindfulness exercises are often utilized in talk therapy approaches by therapists from a range of theoretical orientations.

Types of Somatic Therapy

Somatic therapy comes in many forms, each with its own unique objectives and benefits. Here are a few types of somatic therapy:

• Somatic experiencing therapy: Aimed at helping people heal from trauma, somatic experiencing therapy focuses on releasing trauma that remains trapped in the body.⁹
• EMDR: Eye movement desensitization and reprocessing (EMDR) therapy uses bilateral stimulation to help people suffering from the effects of trauma in reprocessing distressing memories.
• Sensorimotor: Sensorimotor therapy focuses on healing trauma and unhealthy early childhood attachment relationships, exploring painful memories through words, somatic sensations and movements.
• Hakomi method: The Hakomi method combines experiential techniques with somatic awareness to promote psychological growth, integrating principles of Eastern philosophy including Buddhism and Taoism.
• Bioenergetic analysis: This approach, based on the mind-body connection, involves a trained therapist helping a client through physical exercises to release patterns of tension stored in the body as a result of emotional patterns.
• Biodynamic psychotherapy: Developed by Gerda Boyesen, biodynamic psychotherapy focuses on the mind-body-spirit connection, integrating a range of interventions to holistically heal the mind and body as one.
• Brainspotting: Brainspoting therapy is based on the idea that the effects of trauma can get “stuck” in the body, causing physical and mental distress. Certain eye positions, or “brainspots,” can help the relevant areas of the brain process challenges from the inside out.¹⁰
• Breathwork: Breathwork involves a variety of breathing techniques that aim to improve wellbeing. By altering a person’s breathing pattern, encouraging slow, deep breaths, or breathing in a conscious manner, the client can achieve reduced stress and healing.

Somatic Therapy Techniques

Somatic therapies are generally diverse, within the somatic field there are a variety of accepted modalities including the bottom-up processing associated with SE as well as tai-chi, dance movement therapy, yoga, progressive muscle relaxation, general movement or touch and physical awareness.

Techniques used in somatic therapy include:

• Grounding: A body-focused approach that refers to a person’s ability to experience themselves through their physical presence. The purpose of grounding is to express the emotional experience through physical action.¹¹
• Boundary Development: Boundary development involves fostering client awareness of the current surroundings and encouraging them re-establish boundaries as the environmental and social circumstances change so that they can respond in a way that is resilient and that feels safe.¹²
• Self-Regulation: Encouraging the client to increase mindfulness during periods of emotional intensity while developing the ability to respond adaptively. A 2020 study found that using body-based, self-regulation practices with women struggling with addiction showed a significant increase in well-being.¹³
• Movement and Process: Body-focused therapies incorporate the whole body as an agent for recognizing and changing emotional states. Body movement including postures, gestures, and use of space are utilized as a means to understanding the individual experience and ability to heal.¹⁴
• Sequencing: Analyzing sensorimotor tension throughout the body as a means to emotional release. Tension moves throughout the body as a means of processing and helps emotional healing.¹⁵
• Touch/Massage: The intentional and attentional use of touch/massage directly stimulates the autonomic nervous system and can accelerate healing the parts of the self that have been holding onto stress due to adverse experiences.¹⁶
• Titration: The process of experiencing minor exposure to stressors with the goal of increasing resilience and decreasing pain. The therapist will analyze muscle tension, breathing changes and other physical responses to gauge both progress and effectiveness.¹⁷

What Can Somatic Therapy Help With?

Somatic therapy is beneficial in reducing stress within the body as a result of anxiety, depression, trauma, relationship issues and other mental health issues. Somatic treatment builds resilience through strengthening the mind-body connection. This is achieved through assessing sensations, gestures, and tension within the body through a variety of modalities including the use of touch/massage, somatic experiencing, movement, breath work and awareness dialogue.^1,2,3,4,6,7

Somatic therapies are most commonly utilized with people suffering from the following:⁶

• Post-traumatic stress disorder (PTSD)
• Trauma
• Anxiety disorders
• ADHD
• Grief and loss
• Addiction
• Depressive disorders

Benefits of Somatic Therapy

Somatic therapy works with the body’s organic processes to promote healing. There are many benefits of somatic therapy, some evidence-based and others anecdotal.

The benefits of somatic therapy can include:¹⁸

• Reduced stress
• Improved mood
• Increased bodily awareness
• Improved self-esteem
• Symptom reduction related to PTSD
• Better interpersonal relationships

Is Somatic Therapy Effective?

Somatic psychotherapy is effective in treating trauma. The most research has been conducted in the area of using somatic therapy in trauma work.^6,7,19,20 A review examined the effectiveness of somatic experiencing (SE) on post traumatic symptoms yielded positive results.⁷

Additional research on trauma and somatic therapy showcased that incorporating the body as a means to promote grounding, boundaries, movement, and touch can be instrumental in the healing process.^6,7,19,20 Researchers found that after using somatic approaches to therapy, 44.1% of participants no longer met the criteria for a diagnosis of PTSD.¹⁹

Somatic Therapy Criticism

Somatic therapy lacks the strong evidence-base that other, more thoroughly researched interventions, like CBT, have. For this reason, insurance companies may not be willing to pay for somatic therapies. The use of touch in somatic therapy may also trigger some clients who have experienced physical abuse or related traumas.

Risks of Somatic Therapy

Risks of somatic therapy include misinterpretation of touch, re-traumatization, breaking down of defenses, abusive touch and inappropriate regression.^21,22 Researchers determined that all of these risks are rooted in the abuse of the therapeutic relationship and that these risks often become the misguided criticisms of its usage.²¹

• Misinterpretation of touch and abusive touch pose a risk due to the inherent intimate nature of being very physically close and emotionally vulnerable. Abusive touch is deemed a ‘double insult’ as it is not only an inappropriate misuse of the therapeutic alliance but also is classified as physical assault.^21,22
• Re-traumatization is a risk when treating anyone with a trauma history. The largest concern with re-traumatizing a client is that re-experiencing the trauma can prolong the damage of the original trauma. It is suggested that psychotherapists proceed consciously when working with patients with a trauma history, regardless of the theoretical orientation.²¹
• Another risk is inappropriate regression, which is regression that lacks therapeutic purpose and may result in an infantile dependency between the client and the provider reminiscent of parent-child relationship.²¹

These risks can be addressed by offering improved and credible standards for training as well as increased and adequate supervision.²¹

Somatic Therapy Examples

Somatic therapy surveys sensations, gestures, and tension within the body through a variety of modalities. Somatic therapies are most commonly used with trauma disorders such as PTSD, however, due to the comorbid nature of trauma disorders with depression, anxiety and substance abuse, somatic therapies have applicability with these disorders as well.

Somatic therapies can be used in addition to traditional psychotherapies. One study that examined the use of somatic therapy in women with addiction suggested an increase in well-being after the addition of somatic practices in conjunction with regular substance abuse treatment.¹³

Somatic Trauma Therapy

Somatic experiencing is a trauma-focused body therapy aimed at utilizing bottom-up/ground-up processing as a means to modify the trauma-informed stress response. Sessions involve a client monitoring their physical sensations in efforts of developing awareness. The client is then able to process through trauma by increasing their tolerance to the accompanying physical tension and sensation. Preliminary evidence suggests that this may be an effective tool to use in conjunction with psychotherapeutic approaches.¹⁹

Dance & Touch as Somatic Therapy

Dance as well as massage are also popular forms of somatic therapy both in the treatment of trauma and other disorders. Dance also activates an emotional response and promotes self-regulation and grounding through movement. The process of analyzing sensorimotor tension throughout the body as a means to emotional release. Tension moves throughout the body as a means of “ground up” processing and aids in emotional healing.^15,16

How to Find a Somatic Therapist

Choosing the right therapist can be daunting and stressful. It is important for one to do research into what they are looking for in a somatic practitioner in terms of both credentials as well as areas of expertise. Some providers are certified in one modality such as somatic experiencing while others incorporate dance, yoga, or grounding. Some practitioners such as massage therapists and psychotherapists may use somatic therapies in conjunction with traditional approaches.^2,23

The Federation for Therapeutic Massage and Somatic Experiencing International are two resources to learn more about specific credentials and training standards in becoming certified in the use of somatic therapies. To locate providers who have a background in mental health in addition to particular specializations, you can also search an online therapist directory.

How Much Does Somatic Therapy Cost?

The sessions can range from 60 to 90 minutes and the cost depends on the level of the clinician’s expertise and location where services are provided.^2,3,4 The general cost of therapy can range anywhere from $100-225/per session. Due to the lack of empirical data and standardized, credentialed training, many somatic practitioners may not be covered by insurance.²¹

Psychotherapists may also use somatic therapy in conjunction with traditional psychotherapy, in which case the somatic therapy may be able to be billed through mental health insurance. Of note, there is no CPT code that coincides with somatic therapy specifically.²⁵

What to Expect at Your First Appointment

At your first appointment you can expect the practitioner to conduct an assessment geared towards the area of complaint. Given that there is a wide range of practitioners that provide somatic treatment, the first appointment may differ. A massage therapist may focus heavily on the body while a psychotherapist will incorporate mental status as well as some type of comprehensive assessment.

The goal of the first appointment for any practitioner is to gather information about the ailment, establish safety, answer questions and provide some education about body-centered treatment. Once a comfort level is achieved, the working phase of somatic healing can begin.²⁵

Final Thoughts on Somatic Therapy

Somatic therapy is a psychobiological approach to treatment that is aimed at using the body as the main form of healing from psychiatric and physical ailments. This body-centered approach trains individuals to be more in tune with the physical sensations that manifest as a result of mental health struggles.