Somatic methods for trauma: work that goes through the body

“I’ve talked about it so many times that I can tell the story without a single feeling. I understand why it happened, I understand it wasn’t my fault. But when someone opens a door quickly behind me, my heart still jumps into my throat.”

Many people with a traumatic experience know this gap between the head and the body. Reason has done its work: the story has been told, explained, even accepted. The body, meanwhile, reacts as if it hasn’t heard a word. It is precisely because of this gap that approaches developed which, in treating trauma, don’t begin with words but with what lies beneath them: the breath, posture, tension, the impulse to pull away. We call them somatic methods, from the Greek word soma, body.

Before I go on, let me say where I stand. I am a marriage and family therapist in training under supervision, and I am training in relational family therapy. I do not practise somatic methods, and I am not a trauma specialist. This post is a map: what these approaches are, what research tells us about them, what we don’t yet know and how to recognise a professional who is genuinely trained in them.

What “somatic” means

The word somatic is used very broadly today — from serious psychotherapy methods requiring years of training to weekend courses that promise you will “shake the trauma out of your body”. So it helps to draw some distinctions.

Body psychotherapy is a wider family of approaches that bring the body into therapeutic work, not only for trauma. Its roots go back as far as Wilhelm Reich, and I wrote a short introduction to it in The body says what we cannot put into words: an introduction to body psychotherapy. Somatic methods for trauma, on the other hand, are a narrower group of approaches developed specifically to help people whose nervous system has remained stuck in a state of overwhelm or numbness after traumatic experiences.

They all share a few assumptions. That trauma is recorded not only as a story but also as a bodily pattern — in readiness to flee, in a held breath, in numbness. That this pattern doesn’t change simply because you understand it. And that it has to be worked with slowly, because contact with bodily sensations that comes too fast can overwhelm a person rather than help them. I explained in more detail how trauma becomes written into the body, and why the body reacts faster than thought, in How trauma stays written in the body — and how the body can let it go; here I will focus mainly on the methods.

Top-down and bottom-up

In the trauma literature you often come across two terms. Top-down approaches begin with thoughts and meaning: the person talks, questions beliefs, builds a new understanding, and the body — hopefully — calms down in their wake. Bottom-up approaches begin with the body: with noticing sensations, movement, the breath, and only then move towards meaning.

Good trauma treatment usually uses both, just in different proportions. Somatic methods give priority to the second route. For some people this is a relief: they can’t or don’t want to describe in detail what happened, or they have already done so and it didn’t help. The body offers them a different way in.

One of the better-known attempts to test whether working through the body helps was a study by Bessel van der Kolk and colleagues from 2014. It included 64 women with chronic post-traumatic stress disorder for whom previous treatment had not been enough. Half attended yoga adapted for people with trauma for ten weeks; the other half attended a health education group. At the end, around half of the women in the yoga group no longer met the criteria for post-traumatic stress disorder, compared with around a fifth in the comparison group. The study is small and doesn’t tell the whole story — but it shows that working through the body is more than a nice idea.

Three approaches in brief

There are several somatic methods, but three are the most widespread and the most researched. Each has its own founder, its own language and its own training pathway.

Trauma-sensitive yoga differs from an ordinary yoga class in a few important details. The teacher doesn’t adjust postures by touch, instructions are invitations (“if you like, you can …”) rather than commands, and the emphasis is not on how a pose looks but on what the person feels in their body while doing it. For people whose choice over their own body was taken away in trauma, simply being able to decide whether to raise an arm can be a significant experience.

Besides these three there are other approaches — from Hakomi to tension-release exercises based on shaking. For some of them research is still very thin. Shaking the body can be a pleasant way to release tension, as described in the shaking the body exercise in the knowledge base, but that is something different from trauma treatment.

Somatic Experiencing: drop by drop, not in a wave

Somatic Experiencing was developed by the American researcher Peter Levine, who observed how animals in the wild shake off a life-threatening encounter and return to balance. His thesis is that in humans a defensive response — flight, fight or freezing — sometimes remains incomplete and therefore returns in the form of bodily symptoms. It is a vivid explanation that has not been fully tested, but the method itself has two concepts that are useful well beyond it.

The first is titration. The term is borrowed from chemistry, where you add a reagent drop by drop so the reaction doesn’t flare up. In therapy it means the person touches a difficult bodily sensation only a little, for a few moments, and then moves away. The second is pendulation, swinging: attention moves back and forth between what is difficult and what, in the body or in the room, feels pleasant or at least neutral — therapists call this a resource.

The idea is simple, but in practice it takes a great deal of skill. If the therapist takes the person too far into a difficult sensation, it overwhelms them — the heart pounds, thoughts get muddled, sometimes they shut down. If the therapist keeps them too far away, nothing changes. The path lies somewhere in between, in the zone we call the window of tolerance. I explained how this window works in everyday life in The window of tolerance: why you sometimes flood and sometimes go numb.

Sensorimotor psychotherapy: what posture says

Sensorimotor psychotherapy was developed by the American therapist Pat Ogden. More than Somatic Experiencing, it is connected to classical psychotherapy — it draws on attachment theory and works with emotions and beliefs — but it continually tracks what is happening in the body along the way.

The therapist notices small things: how a person contracts at a particular memory, how a hand stops mid-gesture, how their posture collapses when someone is mentioned. The therapist doesn’t interpret these observations but invites the person to notice them for themselves. Sometimes together they explore a movement that wasn’t possible at the time — for example, the person slowly stretches an arm out in front of them, as if stopping someone, and notices what happens. For someone who froze in childhood because they couldn’t defend themselves, the experience that an arm can say “stop” can be surprisingly powerful.

In relational family therapy, in which I am training, the body matters too, but in a different way: we are interested in how the emotional atmosphere of the family a person grew up in repeats itself in their present relationships — physically as well, in how someone tenses up or withdraws around their partner. I don’t, however, practise specialised somatic work.

What research shows — and what it doesn’t

Honesty is needed here. Somatic methods are popular, but the research on them is thinner than for the methods that international guidelines for post-traumatic stress disorder recommend most strongly — trauma-focused cognitive behavioural therapy and EMDR.

For Somatic Experiencing there are a few randomised studies, among them a 2017 study by Danny Brom and colleagues which showed a reduction in symptoms in people with post-traumatic stress disorder compared with a waiting-list group. A review published in 2021 by Kuhfuß and colleagues concluded that the results are promising, but that studies are few, often small and methodologically weak. For trauma-sensitive yoga the findings are similar: encouraging, but from small samples. For sensorimotor psychotherapy there are even fewer controlled studies.

The theories somatic methods often draw on also deserve a critical look. Polyvagal theory, which many somatic therapists use as an explanation, is contested among physiologists — some researchers, such as Paul Grossman, have sharply criticised its basic premises. This doesn’t mean the methods that refer to it don’t work. It does mean the explanation of why they work is less solid than it is often presented to be.

My view: somatic methods are a sensible part of trauma treatment, especially for people for whom talking alone hasn’t helped or for whom telling the story is too hard. But they are not (yet) a first-line method according to the guidelines, and anyone who presents them as proven to be better than the alternatives is claiming more than we know.

What a session looks like

Many people are wary of somatic methods because they imagine something dramatic — crying, shouting, outbursts. Good somatic work is just the opposite: slow, quiet, often almost invisible from the outside. A short excerpt might sound like this (composed, not a real person):

“When I mentioned your sister, you leaned back a little. Did you notice?”
“No. Well … now that you say it, yes.”
“What do you feel in your body when you lean back like that?”
“Like I want to move away. There’s a tightness in my chest.”
“Let’s stay with that for just a moment. Then look out of the window and tell me what you see.”
“A tree. The wind is moving it.”
“What happens to the tightness in your chest while you look at the tree?”
“It eases a bit.”

There is nothing spectacular in this excerpt. But the person experienced something important: that they can move towards an unpleasant sensation and also move away from it. That the sensation doesn’t swallow them. This is the foundation on which everything else is built.

Touch can also come into somatic methods — for example the therapist’s hand on the back, offering support. For people with trauma, touch is never something to be taken for granted. A good therapist always asks, explains why they are suggesting it, and accepts a “no” without needing a reason. If touch feels uncomfortable to you, you have every right to say so and to decline it.

How to choose a therapist, and when to seek help

Because “somatic” is not a protected term, choosing a therapist matters especially here. A few questions worth asking:

• What foundational psychotherapy training do they have? A somatic course without it is not enough for trauma work.
• Where did they train in the somatic method, how long did it take, and is their work supervised?
• What do they do if someone becomes overwhelmed or shuts down during a session?
• How do they approach touch — do they use it, and how do they ask for permission?

Be wary of promises that you will “release” trauma in a few sessions, and of approaches that seek strong emotional outbursts. Catharsis can bring momentary relief, but with trauma, overwhelm rarely heals; often it only confirms the sense that the inner world is dangerous.

And me? Because I work with relationships, I often see how one person’s trauma shows up across the whole system: a partner doesn’t understand why the other shuts down at a certain tone of voice, children learn to tiptoe. I can help with that. But if we find that you would benefit from specialised trauma treatment — somatic or otherwise — I will tell you so, and we will think together about where to turn.

If your distress is so overwhelming that you can’t cope, or you are having thoughts of harming yourself, don’t wait. In Slovenia you can call the crisis line Klic v duševni stiski on 01 520 99 00 (7 pm to 7 am) or the Samaritans helpline on 116 123 (24 hours a day), and in an emergency 112. If you are experiencing violence, the SOS helpline for women and children who are victims of violence is available in Slovenia on 080 11 55.

An exercise for today: swinging between difficult and supportive

This exercise borrows the idea of pendulation, but it is not therapy and it is not meant for bringing up traumatic memories. Use it with everyday tension — after a tiring day, before a demanding conversation. If something very strong comes up during it, stop and ground yourself, for example with the grounding 5–4–3–2–1 exercise.

1. Look around the room. Slowly turn your head left and right and let your eyes rest on something pleasant or at least neutral: a colour, a plant, the light. This is your resource.
2. Find support in your body. Where does your body feel most all right just now? Perhaps your feet on the floor, your hands in your lap, the warmth of your palms. Stay there for a few breaths.
3. Touch the tension — a little. Notice where in your body you feel tension. Don’t go deeper into it, just name it: tightness, heaviness, heat. Stay with it for only a few seconds.
4. Return to the resource. Move your attention back to the pleasant place in your body or to the object in the room. Notice what happens to the tension while you weren’t looking at it.
5. Swing a few times. Repeat two or three times: briefly to the tension, longer to the resource. At the end, stay with the resource and notice whether anything is different from the start. If it isn’t, that’s fine too.

Where the body is no shortcut

Because somatic methods have become so popular in recent years, it is worth saying what they can’t do.

The body is no substitute for safety in the present. If someone lives with a person who threatens them, no breathing exercise will calm a nervous system that is correctly perceiving danger. Then the first task is safety, not regulation.

Not every bodily symptom is trauma. A racing heart, pain, fatigue and digestive problems can have physical causes that a doctor needs to examine. Explaining everything too quickly through trauma can mean missing an illness that needs treatment.

Words still matter. Somatic approaches don’t say that talking is unimportant — only that on its own it isn’t always enough. Many people need both: an experience in the body and a story that gives it meaning. And let’s not forget: suffering in itself doesn’t heal either. I wrote about why in “What doesn’t kill you makes you stronger” — why that isn’t true of trauma.

And it doesn’t have to be for everyone. For some people, directing attention into the body is unpleasant, even threatening, especially when the body itself was the scene of the trauma or when they often dissociate. For them a path that starts elsewhere may be better, coming to the body later — or never putting it centre stage.

What to remember

• Somatic methods for trauma start with the body — with sensations, posture and movement — and only then with meaning.
• The most widespread are Somatic Experiencing, sensorimotor psychotherapy and trauma-sensitive yoga.
• The key is working in small doses, within the window of tolerance, swinging between the difficult and the supportive.
• The research is promising, but thinner than for the methods the guidelines recommend most strongly.
• Choose a therapist for their foundational training, their specific training and whether they respect your “no”.