Talk therapy works through conversation and insight. Somatic therapy works with the body as well, because trauma is held in the nervous system, not only in memory.
Every therapist at Seattle Trauma Counseling is trained in somatic methods, and in our experience it is the most effective way to treat trauma. Here is how the two differ, what the research actually says, and what a somatic session is like.
Psychotherapy is psychological treatment that happens through talking, inside a safe and non-judgmental relationship. The relationship itself does a lot of the work. It gives you room to explore what is troubling you, whether that is a mental health condition or the ordinary problems of daily life, and it is designed to support the kind of inner growth that may not have been possible earlier in your life.
Most talk therapy is built on the idea that our present perceptions and behavior are conditioned by our past, so the past is where the conversation tends to go. Psychodynamic therapy works through verbal reflection, raising awareness gradually so that symptoms ease over time. Cognitive behavioral therapy, the most widely used form of talk therapy, works on the thoughts, images, beliefs and attitudes you hold, the mental evaluations you make of your own feelings, and how those drive what you do.
Talk therapy helps a great many people. For questions of identity, relationships, decisions and the strains of everyday life, it is often exactly the right tool.
When the problem is trauma, talking has limits, and the reason is simple. Trauma does not live only in the story. It lives in the body, in the breath that catches, the shoulders that never quite drop, the sense of danger that arrives before any thought does. You can understand your history completely and still feel the knot in your chest. In our experience this is the most common reason people come to us after years of talk therapy that helped in some ways but never reached what they feel is the core wound. It is especially true of complex trauma and of dissociation, where the body learned its responses long before there were words for them.
There is also a risk in retelling. Telling the story of the trauma again and again, as some exposure-based approaches ask you to, means reliving it again and again. For some people that intensifies the feelings attached to the memory rather than releasing them, and they leave sessions feeling worse than when they arrived.
The research here is more careful than either side of the debate usually admits, so we will be careful too.
Bessel van der Kolk, in The Body Keeps the Score (2014), argues that reliving traumatic memory in therapy can overwhelm rather than heal when a person has not first been prepared and resourced, and that effective treatment has to reach the body, not just the narrative.
Jonathan Bisson and Martin Andrew, in their 2007 Cochrane review of psychological treatments for PTSD, found that trauma-focused approaches, including trauma-focused CBT and EMDR, are effective for many people, while noting that some experience a temporary worsening of symptoms during exposure. So story-based methods do work for many, and the cost along the way is real for some.
Maggie Schauer, Frank Neuner and Thomas Elbert, in Narrative Exposure Therapy (2011), acknowledge that a narrative approach can reactivate trauma and deepen symptoms when the story is revisited repeatedly without effective emotion regulation strategies in place.
Marylene Cloitre and colleagues, in a randomized trial of treatment for PTSD rooted in childhood abuse, found that teaching emotion regulation and relationship skills before any memory work produced better outcomes than memory work alone.
Judith Herman, in Trauma and Recovery, set out the phase model that most trauma specialists still work from. Safety and stabilization come first, processing of the trauma comes second, and reconnection with ordinary life comes last.
Put together, the research does not say that talking is wrong. It says that the order matters, that the body matters, and that the ability to stay regulated has to be in place before the story is worked with. That is the position somatic therapy is built on.
Somatic psychology is a branch of psychotherapy that takes the connection between mind and body seriously. The word soma comes from the Greek for the body in its living, breathing form. Somatic psychotherapy is grounded in the understanding that your mental, emotional and physical experience are one interconnected system, and that healing in one area creates change in the others.
The trauma physician Robert Scaer put it plainly in The Body Bears the Burden. Brain and body are parts of a single interactive system, each continuously changing the other, so if trauma has affected either one, healing has to include both.
In practice, somatic psychotherapy combines body-based methods with mindfulness. Mindfulness is an ancient practice that has found its way into modern treatment. It is a non-critical state of self-observation, a way of being consciously aware of what is happening in you without evaluating it, which lets your awareness become separate from your thoughts, feelings and judgments. Somatic methods are hard to define on paper because they are experiential by nature. They involve the direct, conscious experience of your own body in relation to the events you are trying to overcome and release.
Talk therapy: in the mind, through thoughts, insight and the story
Somatic therapy: in the body and nervous system, as well as in thoughts
Talk therapy: top down. Understanding changes how you feel
Somatic therapy: bottom up. Settling the body changes how you think
Talk therapy: told, examined and often retold
Somatic therapy: approached only once you can stay present, and often without detailed retelling
Talk therapy: talk
Somatic therapy: talk, pause, notice sensation, track it, let it settle, talk again
Talk therapy: psychodynamic therapy, CBT, exposure therapy
Somatic therapy: Sensorimotor Psychotherapy, EMDR, Brainspotting, IFS, TRE, Safe and Sound Protocol, Focusing
Talk therapy: insight, decisions, relationships, coping skills, problems of daily life
Somatic therapy: trauma, PTSD, complex trauma, dissociation, anxiety that lives in the body
Talk therapy: not opposites. Somatic therapists talk too
Somatic therapy: the body leads and the talking follows
You sit with your therapist and you talk, the same as anywhere else. The difference is what your therapist is paying attention to, and what happens when something stirs.
As you speak, your therapist notices what your body is doing, a held breath, a shift in posture, a hand that closes. At the right moment they will ask you to pause and notice it too, without judging it. You slow down. You stay with the sensation long enough for it to change, and it does change, often more than talking about it ever managed. Then you talk again. Talk, pause, notice, settle, talk. Inside those cycles the nervous system gets the time it needs to digest what happened to it.
Depending on the method, your therapist might add sets of eye movements, a fixed spot in your visual field, gentle tremoring, specially filtered music, or a conversation with a part of you that has been carrying the weight. You stay in control throughout. Nobody makes you relive anything, and if it ever becomes too much you say so and the pace changes. Early sessions are mostly about building the ability to stay present in your body. Processing comes later, when you are ready for it, which is also the difference between PTSD and a normal response to trauma starting to resolve on its own.
Somatic psychology is guided by several traditions and, more recently, by research in infant development, neurobiology and attachment. As a method for treating trauma it rests most heavily on the work of:
• Dr. Bessel van der Kolk, author of The Body Keeps the Score
• Dr. Stephen Porges, originator of the Polyvagal Theory
• Dr. Robert Scaer, author of The Body Bears the Burden: Trauma, Dissociation, and Disease
• Pat Ogden, author of Trauma and the Body and founder of Sensorimotor Psychotherapy
• Kathy Steele, Suzette Boon and Onno van der Hart, authors of Treating Trauma-Related Dissociation
• Dr. Judith Herman, author of Trauma and Recovery
Many other clinicians and researchers have shaped this field over the last thirty years, and we encourage you to explore it further on your own.
Sensorimotor Psychotherapy is the method closest to the description above, working directly with posture, movement and sensation. EMDR and Brainspotting use eye position to reach and process trauma the body is holding. Internal Family Systems, often called parts work, helps the protective parts of you step back so the hurt parts can heal. Lifespan Integration helps the past feel like the past. Trauma Release Exercises and the Safe and Sound Protocol work on the nervous system directly, one through the body’s own tremoring reflex and one through filtered sound and the vagus nerve. Focusing is a mindfulness-based way of listening to what the body knows before it has words.
For people who want to go deeper, faster, we also offer therapy intensives. We match the method to you rather than fitting you to a method, and you can read about all of our approaches in one place.
We see people in person at our Edmonds office and our Kirkland office, both by appointment, and online across Washington for anyone who prefers telehealth or lives further out. Whether you already know what you are dealing with or simply know that talking has not been enough, the place to start is a free consultation.
We will talk it through, help you meet our therapists and find the right fit, and there is no pressure to decide anything on the call.
Somatic therapy is psychotherapy that includes the body. Soma is the Greek word for the living body. Instead of working only with what you think and say, a somatic therapist helps you notice sensation, posture, breath and impulse, because trauma is held in the nervous system, not just in memory. Mindfulness is the tool that makes this possible.
Talk therapy works through conversation and insight, exploring how the past shapes your present thinking and behavior. Somatic therapy works with the body’s response in the present moment, so you can settle a nervous system that is still reacting as if the danger were here. Most of our sessions involve both, but the body leads.
It can, for some people, when the story is retold again and again without the tools to stay regulated while doing it. Several researchers have noted that repeated exposure to traumatic memory can temporarily intensify symptoms. That is why we build the ability to stay present in the body before any processing of the events themselves begins.
Yes. You are never asked to sit in silence or to skip your story. The difference is that you will not be asked to relive it in detail over and over. Your therapist tracks what happens in your body as you speak and helps you slow down, notice and release, so that talking becomes part of the healing rather than a rehearsal of the pain.
Some of it strongly, some of it less so, and you deserve a straight answer. EMDR has a large research base and is recommended in major PTSD treatment guidelines. Sensorimotor Psychotherapy, Brainspotting, TRE and the Safe and Sound Protocol have smaller but growing bodies of research, and the science of the nervous system that underpins them is well established. We tell you which is which, and we choose methods based on what works for you.
Our therapists are trained in Sensorimotor Psychotherapy, EMDR, Brainspotting, Internal Family Systems, Lifespan Integration, Trauma Release Exercises, the Safe and Sound Protocol and Focusing, among others. We match the method to you rather than fitting you to a method. A free consultation is the easiest way to work out where to start.
Contact us to schedule a free consultation session. In Person In Kirkland And Edmonds, Online Across Washington