How do I integrate Somatic Experiencing® (SE) into my practice? Reflections of a psychologist

[ A shortened version of this article is published on the Somatic Experiencing® Aotearoa website, and was commissioned by them. https://seaotearoa.co.nz/reflections-of-a-psychologist-integrating-somatic-experiencing-into-my-practice/]

I was introduced to Somatic Experiencing®(SE) by a dear colleague of mine. I remember she said, "I now have a deep sense and appreciation for the nervous system that underpins all that we do — no other training will help you gain this profound understanding of the nervous system" (or something along those lines). There was something in the way she spoke that tugged at a heartstring, and I felt compelled to develop the same appreciation.

As I watched Peter Levine and the SE trainers work and experienced SE sessions myself, I became increasingly amazed by the subtle yet profound shifts it enabled both in myself and in my clients. SE’s focus on “soma,” or the lived experience of the body, has only recently gained prominence in psychology. Over the last decade, since I discovered SE, I’ve seen a growing recognition among psychologists and psychotherapists of the body’s crucial role in healing.

In South Africa, where I initially trained, the SE programme was delivered by psychologists and closely tied to regulatory standards and continuing professional development, which helped validate and establish the approach. When I later trained in New Zealand, the SE programme welcomed professionals from various disciplines. This broadened my perspective and allowed me to learn alongside body-oriented modalities. Growing international research and the concept of practice-based evidence now support the inclusion of SE in psychology, especially as neuroscience continues to advance our understanding of trauma and memory reconsolidation.

The Evolution of Trauma Interventions

Somatic Experiencing is ideally suited for people who have endured trauma. As is typical of most psychologists, and definitely from anyone who has been in academia, it helps to look at the evolution of the field, as described by Spermon et al. (2010). They discuss three waves of trauma intervention/therapies. The first wave, rooted in the psycho-analytical tradition, emphasises catharsis or expressing unconscious conflicts. The second wave, emerging in the 1980s and 1990s, differentiated between single-incident, adult-onset, or more chronic interpersonal trauma such as childhood abuse. Various schools of therapy developed, mainly within a three-stage model of safety and stabilisation, processing trauma memories, and finally reconnecting with the broader social environment. Examples are Trauma-focused CBT, Cognitive Processing Therapy, EMDR, brief elective psychotherapy, narrative exposure therapy, and present-centred therapy (Watkins et al., 2018). Part of the second wave also focused on the soma as an entry point for intervention, such as Ogden’s sensorimotor psychotherapy, Kurtz’s Hakomi method, and Levine’s Somatic Experiencing (Spermon et al., 2010). The third wave, from the mid-1990s to 2000, refined the understanding of trauma’s effects on memory and emphasised the building of a more coherent self-narrative. SE therefore originates in the second wave, but holds as its core the principles of the third wave as well, and recent insights from neuroscience as alluded to above.

The importance of the body from a cultural perspective

As a psychologist in New Zealand, we have been privy to an indigenous framework called Te Whare Tapa Whā^[1]. Therefore, in my work, I am continuously curious and exploring how the intersection of Te Whare Tapa Whā and Somatic Experiencing influence Taha Tinana and Taha Hinengaro, and indirectly, on a more subtle level, Taha Wairua and, by implication, Taha Whenua.

The concept of embodied knowing is also reflected in the concept of “Rongo”. McLachlan et al. (2024, p.3) state that “Rongo is connected to all types of sensory information and knowing and may also be experienced as an internal sensation that eludes precise definition… and understanding internal sensations as located within the body, rather than exclusively within the roro (brain)”. This then leads to a kaupapa Māori (Māori-centred) focus on the importance of Taha Tinana. Taha Tinana is usually summarised as physical health, which is required for optimal development. The “physical being” of someone supports their essence and cannot be separated from the aspects of mind, spirit, and family. It is this physicality, the essence of being spirit (Wairua) and mind/ emotion (Hinengaro) within a body (Tinana), that I argue trauma affects and needs attention in the therapeutic process.

Gendlin (1997, in Winhall & Porges, 2022, p. 18) touches on this perspective through his philosophy of the implicit and the concept of the “felt sense”.  He stated that the body’s implicit knowing is beyond our conscious awareness. Gendlin discovered that clients who did well in therapy were connected to their body and its implicit knowing. This knowing is at first vague. Turning attention inwards and noticing feelings and body sensations allows a felt sense, a whole sense of a situation, to form in the body. As Levine (1997, p. 8) states, “The vehicle through which we experience ourselves is the felt sense”. Embodied knowing is implied in the next step towards growth. Though natural, embodied awareness can be challenging in today’s disembodied culture. Furthermore, Payne et al. (2015, p.1) state:

 We emphasise the importance of taking into account the instinctive, bodily-based protective reactions when dealing with stress and trauma, … as a supplement to cognitive expressive-based therapies.”

Clients learn to value this relationship between thoughts and body, and how it affects each other. For example, in one session, a client reported:  “If I sense into it… I do feel that, I sense that in my body. Yeah. Interesting. It is, like, just to be aware of how different your body feels when you're thinking about different things. “

This requires practitioners to slow down, to work in a titrated way, as clients are not always used to this nor is it what they expect from “typical talk therapy”. Titration in SE is the gradual and careful introduction of traumatic material to help clients process it in manageable steps, rather than all at once, to prevent overwhelm and retraumatisation.

I have come to learn that less is more, and slower is better in trauma work. Our brains don’t like this (or at least mine doesn’t). Titration means that we slow things down, as trauma happens “too much, too fast, too soon,” and we want to counter this in trauma renegotiation. Slowing down looks like working with small pieces of difficult experiences at a time. It’s about taking a pause and noticing what’s happening in your body while you’re talking about something. When we do this, the body often naturally starts to move towards the completion of protective responses that we were unable to complete in the past.

Let's get practical!

SE changed the way I start any therapy session. Orienting and proximity have become a key focus. I allow clients to choose where they sit so that their nervous systems can make the choice, be it conscious (with awareness) or not. Some clients will affirm once I make this explicit that they chose to sit close to the door or with a certain perspective to see through a window, or to be able to see the door. I sense into my own body felt sense or awareness as to which side of the couch or how close I prefer to sit to a client, and once again, making this explicit in a playful way allows for experiential learning and entry into the concept of the felt sense and how our body “shows up” in everyday life.

Orienting to the room and space usually allows me to see whether someone is ready for exploratory orienting, or whether a more defensive stance is triggered within the nervous system. I want to add that I am not “testing” someone, but through subtle observation, I can become aware of the client's nervous system state and help make that explicit alongside them. Orienting, to find yourself in space and time, is such a great resource. We also orient to each other, allowing an entry point into attunement and attachment. And as always, it allows for orienting towards the felt sense and interoception, and safety (or the absence thereof). Usually, by now, there is such rich material to work with. However, checking in with a client as to their goal for therapy is of super importance here, but for most people, this becomes an eye-opener into how they are “being in this world”.

Somatic resourcing is an entry point into exploring the felt sense. For example, clients can be guided to merely allow their eyes to find something that appeals to them. Clients usually report a sense of relief, as they usually anticipate entering a session with the pressure of having to talk, having to share, which makes them extremely nervous and uncomfortable. The nuanced way of resourcing models to the client that we also want to find what is working and going well.

Doing online sessions, I change this approach slightly, giving people permission from the onset to break eye contact, to allow for peripheral vision to happen and to remain connected to the space around them. Orienting and resourcing easily lend themselves to online work.

By now, I am sure many psychologists resonate with this way of working. So yes indeed, many psychologists work in an integrative way, but even as I draw on different theories, models and approaches, Somatic Experiencing and working with nervous system health is at the forefront. As I write this, I want to acknowledge that by no means can I give a comprehensive account of all the SE principles and methodologies that I draw on. I became tempted to write a SE manual! Contained herein are but a few glimpses.

Probably the essence of SE for me is to notice the relief that the body itself experiences when someone “speaks” to it. This indeed is something that I value as sacred. It usually expresses as tears in the room, sighs of relief, the deepening of the breath, a softening of the tension and bracing held in the system, and an openness and expansion.

Supporting clients with ample explanation as to why we work this way, to deliberately support insight and understanding through psycho-education, helps to integrate the work. Invitational language to support choice and control is also something I had to work on as I started on the SE journey, and I continue to hold it at the forefront of my mind. I also want to acknowledge that sometimes annoyance might show up or even exhaustion with the enquiry regarding somatic experiences. It can feel like you have to draw on a hundred ways to ask: “what do you feel or notice in your body?”

Examples from my practice: a glimpse into the therapy room

I want to share^[2] some vignettes from clients’ therapeutic processes and feedback, to allude to some shifts that are possible.

In one session, a client is holding their breath, and we acknowledge it, we don’t change the breath or “implement a strategy”, we merely witness, and listen to the body, and the body speaks. So we ask it, “what do you need, why are you holding your breath, what do you need to tell me?” The client reported: “the answer that came today was – well, you need to breath – you’ll starve of oxygen, so listen to me, the mind and thoughts need oxygen – so stop for moment and centre – ground – be present – then we can take a full breath, ‘calm down’ – and then the mind can work again – in its pristine form. A powerful illustration of working with sensation (S) and meaning (M), key aspects of SIBAM in SE.

Peter Levine came up with a model for describing how clients process their lived experiences, specifically how traumatic memory can be worked with using present moment experiences. He used the acronym SIBAM to describe five channels of experience present in any given moment of our experience. "S" stands for sensations, "I" for sense memory from visual, auditory, smell, taste, or touch experiences in the past, "B" refers to the client’s movements or behaviours, "A" for affect or emotions and "M" for meanings or the narrative that the client associates with their experience. In SE we use this “SIBAM” model to support clients to work with fragmented trauma memories. This can support untangling of trauma memories and completion of incomplete survival responses as well as integration of these five channels into a more coherent, empowered and embodied experience of themselves.

With another client, we work on Affect (A) and sensation (S) as she recalls a horrifying trauma memory and “rides” the wave of grief and anger. As she connects with these emotions, she notices sensations of shock and feels jittery inside. We explore how she experiences anger, sadness, and grief. This exploration opens up a deeper understanding, and an earlier memory surfaces of feeling neglected and having unmet needs. As she stays with these emotions and sensations, a broader perspective emerges, including a more recent, more wholesome image (linking to the “I” of SIBAM) and different sensations of warmth throughout her body, along with an emotion of love enveloping her heart space.The memories that emerge and the recognition of unmet needs refer to the Meaning (M) channel and are often the focus of psychological therapy. When we concentrate on sensation (S), it frequently allows deeper issues to surface, which can then be explored and integrated, leading to insights and the opportunity to reconsolidate memories, thereby offering new meaning.

Another client is working through the after-effects of a traumatic medical procedure. She shares a deep fear that her right arm will go numb, and describes the arm as feeling disconnected from the rest of her body.

As we begin, we stay with sensation, slowing down to allow a felt sense of the right arm to emerge. We pendulate gently between the right and left arms, noticing the contrast. She explains that she often feels she needs to support the right arm during the day and at night, constantly moving it to reassure herself. Rather than trying to “manage” these thoughts, we stay with the sensations and track what wants to happen next.

Her left arm feels “normal,” light, and easy to move. But the right arm feels heavy, as if made of stones at the bottom of a cold lake. I invite her to stay with this sensation and the image, as much as she can. The heaviness grows; the arm feels colder. Again we pendulate—between the right arm, weighted and cold, and the left arm, free and light.

A fear arises: what if I can never move my right arm again? As we sit with the fear, she notices an impulse to move. We slow it down, titrating the experience, and track how the movement seems to want to begin at the elbow. We follow it carefully, sensing how it extends up into the shoulder.

An image appears: a heavy casket pressing down over her shoulder and chest, constricting movement. We pause, then explore whether the ease of the left side can be imagined as flowing into the right. Suddenly, she says: “My elbow just released, it sank down, but in a nice way, a relaxed way.”

We stay with this shift. Life begins to return to the arm, though at first it feels like a burning cold. I ask what else she notices. A memory surfaces: coming out of a coma, being rolled onto her side, unable to speak, her arm caught and going numb while she could not tell the doctors.

Here, we renegotiate the defensive response. Now we can encourage her to speak up: “My arm is stuck. Get off my arm. Get off my arm.” Her body follows with the impulse to roll, so together we slowly enact the movement. I affirm: “And now you can. You are not in the hospital.” Back and forth, slowly, we revisit the old experience of her arm remembering being stuck, and now discovering it can roll back, it can move.

She reports less panic. Her two hands can now meet and touch, coming into connection. The arm feels warmer, more integrated, more alive. The greatest relief is that both arms now feel relaxed, as though they truly belong to her.

Summarising thoughts

As can be seen in these vignettes, SE as a regulation-informed approach involving small increments, allowing for more subtle changes. It alludes to the value of slow-paced therapeutic work. I have come to a renewed appreciation for processing nonverbal, body-based emotional communication, which occurs moment by moment and often below the level of conscious awareness, beyond what is conveyed through words. As Schore (2022) states, the therapist offers “emotional feedback” in a “right brain-to-right brain emotion communication system,” highlighting the crucial role of attunement. This in turn, can change the client’s unconscious self-image and internal working model of attachment.

Perhaps the greatest benefit of incorporating Somatic Experiencing (SE) into my psychology practice has been its impact on my own growth. I have learned to notice my own regulation and dysregulation, to expand my capacity, and to draw from a deeper energy well. This has helped me tremendously to sit with people’s pain and despair without becoming overwhelmed. Even more powerful is my own experiential knowing on how SE has helped me through troublesome life experiences.

In practice, SE is not always the right fit, and some clients even resist it, and there are times when I return to more familiar approaches such as good old CBT. Yet the sessions I cherish most are those where clients can stay present, notice their experience and track their sensations and accompanying thoughts, emotions, images and so forth. Together we move through pendulation cycles, activate defensive responses, and negotiate them so that the nervous system can complete what it needs to do. In those moments, something shifts — pain eases, heartache softens, and healing becomes possible.

References

·      Levine, P. A. (1997). Waking the tiger: Healing trauma. Berkeley, CA: North Atlantic Books.

·      Levine, P. A. (2008). Sexual healing: Transforming the sacred wound. Boulder, CO: Sounds True.

·      Levine, P. A. (2015). Trauma and memory: Brain and body in a search for the living past. Berkeley, CA: North Atlantic Books.

·      Levine, P. A. (2019). Healing trauma: A pioneering program for restoring the wisdom of your body. Boulder, CO: Sounds True.

·      Schore, A. N. (2022). Right brain-to-right brain psychotherapy: Recent scientific and clinical advances. Annals of General Psychiatry, 21(1), 46.

·      Spermon, D., Darlington, Y., & Gibney, P. (2010). Psychodynamic psychotherapy for complex trauma: Targets, focus, applications, and outcomes. Psychology Research and Behavior Management, 3, 119–127.

·      Watkins, L. E., Sprang, K. R., & Rothbaum, B. O. (2018). Treating PTSD: A review of evidence-based psychotherapy interventions. Frontiers in Behavioral Neuroscience, 12, 258. https://doi.org/10.3389/fnbeh.2018.00258

^[1] https://mentalhealth.org.nz/te-whare-tapa-wha

Te Whare Tapa Whā is a Māori health model developed by leading Māori health advocate Sir Mason Durie in 1984. Te Whare Tapa Whā depicts wellbeing as a wharenui or meeting house. The four walls of the wharenui represent the four dimensions of holistic wellbeing.

https://www.tepūkenga.ac.nz/te-pae-ora/living-well-learning-well/te-whare-tapa-wha#:~:text=Te%20Whare%20Tapa%20Whā%20describes,Whānau%20%7C%20Family%20and%20social%20wellbeing

^[2] Permission/ consent obtained from the relevant clients