The Importance of Somatic Approaches to Trauma Treatment

There are often a lot of misconceptions about therapy. Many of the therapy sessions we see in Hollywood films depict clients pouring their hearts out to silently nodding, onlooking therapists, usually wearing trendy spectacles. (I don’t wear spectacles. Yet.) While this approach to therapy does exist, it reflects a less frequently employed modality. It lends to the common idea that clients have to purge all details of their past to their therapists, sometimes within their first meeting! This can create an intense sense of pressure on the first meeting. But not all therapists or therapies are alike, and there are times when such cathartic monologues may be harmful; especially when trauma is concerned. That’s why it’s important to work with practitioners who specialize in trauma treatment, specifically somatic, or body-oriented, approaches, if you experience these types of concerns.

To understand the importance of this, one must grasp how the nervous system works. When a person is confronted with something their brains and bodies perceive to be threatening (a stressor), their nervous systems automatically react with the stress response, putting them into a state of fight, flight, or freeze, and when these are ineffective, a submit or feigned death (dissociative) state. These are our natural survival mechanisms. Neurologically, during this process, our frontal cortex (or thinking/executive brain) and hippocampus effectively shut down. The evolutionary psychological explanation for this is simple: when we’re confronted with a potential life-threatening stressor, we don’t need to be eating a ham sandwich, reproducing, or thinking analytically; we simply need to mobilize our survival instincts to ensure our safety. And it’s for this very reason that top-down therapy approaches miss the mark when it comes to trauma treatment, because it’s at this level of functioning that we’re most affected by trauma.

Thinking more about neuroanatomy, the frontal cortex, or “primate brain,” responsible for our executive cognition (thinking), uses verbal language and analytical reasoning; the mid-brain, referred to as the limbic system, or “mammalian brain” speaks the language of emotion; and the brainstem, or “reptilian brain” speaks the language of sensation and impulse (Ogden, 2002). There are psychotherapeutic approaches which address each part of the triune brain (the three subsections previously described), such as: CBT for the “thinking brain;” emotion-focused approaches for the “feeling brain;” and sensory-oriented approaches for the “sensory brain.” When we are traumatized, our brainstems are overwhelmed by the threat; the frontal cortex is compromised and we don’t fully encode or process the experience analytically or emotionally. Our trauma response gets ‘stuck’ in the body and continues to activate primitive parts of the brain, implicating impulses and reactions that don’t get fully ‘metabolized’ in higher-level cortical areas. That’s why we need to start with the body in trauma treatment in a bottom-up approach to address the impact of trauma that was stored somatically before we can facilitate subsequent emotional and thinking processes (which happen later in therapy).

Somatic approaches help clients respect their personal limits, such as, how much they can comfortably tolerate in discussion before becoming flooded or overwhelmed. Such approaches incorporate the most recent advancements in the field of neuroscience and teach clients how to regulate their bodies to achieve greater personal safety…before going into the stories. It’s for these reasons that I stop clients from going into detailed accounts of their trauma histories during our first moments together. While my interruption may seem surprising, to allow them to continue may compromise their nervous system functioning and possibly retraumatize them.

In my office, we’ll likely get to the trauma histories and move past them, if a client is ready; but we always go at the nervous system’s pace.