Somatic Therapy

What is somatic therapy?

Somatic means "of the body". Somatic therapy is a talking therapy that also pays close attention to what your body does as you talk. That means your breath, posture and tension, and any urge to move, freeze or pull away.

It is a family of approaches, not one method. Three of them have their own sections below.

How it works

Somatic therapies start from the idea that trauma affects the body as well as the mind. In this view, the body can stay braced or on alert long after the danger has passed.

So instead of only talking about what happened, you notice what happens in your body as you talk. The work goes in small steps. You move between a sensation that feels hard and one that feels steadier.

The aim is for your body to settle, so that it becomes a safer place to be.

Sources: SPI: trauma training, SPI: about, Chiron: body psychotherapy

What sessions look like

Most sessions look like any talking therapy. The difference is how often your therapist asks what you notice in your body. It might be your breath, your feet on the floor or a tightness in your chest.

You might be invited to try a small movement, such as pressing your feet into the floor. You can always say no. Some forms use touch, but only with your informed consent.

Source: Chiron: body psychotherapy

Somatic experiencing

Peter Levine developed it from the 1970s. It grew from his study of how animals deal with threat.

Your therapist helps you notice a sensation a little at a time, which it calls titration. You then move between discomfort and ease, which it calls pendulation. You do not have to share the details of what happened to you.

Training takes about three years, part time. Coaches and yoga teachers can train in it too, and the certificate is not a licence to practise therapy.

Sources: Ergos: somatic experiencing, SEI: professional training, SEI: ethics

Sensorimotor psychotherapy

Pat Ogden began developing it in the 1970s, and founded her institute in 1981. It blends body awareness and movement with talk about thoughts and feelings.

You might notice how your posture shifts as you talk, then try a small change and see how it feels. The work moves through three phases: safety, processing and integration. It draws on attachment, so it looks at early relationships as well as at trauma.

Its trainings are only for people already allowed to practise psychotherapy.

Sources: SPI: about, SPI: curriculum

Biodynamic psychotherapy

Gerda Boyesen, a Norwegian psychologist and physiotherapist, developed it. It combines talk with movement, awareness and hands-on work, including a form of massage.

Any touch is something you agree to first, and you can say no at any point.

Sources: LSBP: training and workshops, Chiron: body psychotherapy

Who it may suit

Somatic therapy can be a good fit if you:

• Feel stress mostly in your body, as tension, a racing heart or a sense of shutting down
• Find that talking about what happened is not enough, or is too much
• Want to feel more at home in your own body
• Are curious about working with breath, posture and movement

Somatic therapy and PTSD

NICE points first to other therapies for post-traumatic stress disorder (PTSD). For adults whose symptoms have lasted more than a month, it says to offer trauma-focused cognitive behavioural therapy.

NICE also recommends eye movement desensitisation and reprocessing (EMDR). It says to offer it from three months after a trauma not related to combat. It looked at somatic experiencing, but found the evidence too small to recommend it.

Our trauma and PTSD page starts with the routes NICE recommends. Both trauma-focused CBT and EMDR have pages of their own.

Sources: NICE NG116, NICE NG116: evidence review D

Not the same as somatic coaching

Coaching has a body-based form too, called somatic coaching. It is coaching, focused on goals and action, rather than therapy for trauma.

Finding a somatic therapist

Anyone in the UK can call themselves a psychotherapist or a counsellor. So check that your therapist is on a register accredited by the Professional Standards Authority.

Sources: POST: regulation of professionals, PSA: accredited registers

The evidence

Interest in somatic therapy has grown, and its trial base is thinner than for the therapies NICE recommends. A 2021 review called the early results promising, and asked for more unbiased trials.

A randomised trial of somatic experiencing included 63 adults with PTSD. Those who had it reported fewer symptoms than those on a waiting list. The trial did not compare it with another therapy.

A later trial added it to physical therapy for back pain with PTSD symptoms. It found no extra benefit.

Sensorimotor psychotherapy has one small pilot trial, of a group for women after childhood trauma. A 2009 review said body psychotherapy did not yet have the evidence to be offered widely by health services. We found no controlled trial of biodynamic psychotherapy itself.

Sources: Kuhfuß et al. 2021, Brom et al. 2017, Andersen et al. 2020, Classen et al. 2021, Röhricht 2009