Somatic Experiencing

Somatic Experiencing (SE) is a form of therapy aimed at relieving and resolving the symptoms of post-traumatic stress disorder (PTSD) and other mental and physical trauma-related health problems by focusing on the client’s perceived body sensations (or somatic experiences). It was introduced in Peter Levine's 1997 book Waking the Tiger. In it, he discusses at length his observations of animals in the wild, and how they deal with and recover from life-threatening situations. He concludes that their behaviour gives us "an insight into the biological healing process" (p. 98), and that "the key to healing traumatic symptoms in humans lies in our being able to mirror the fluid adaption of wild animals" (p. 17-18) as they avoid traumatization in reacting to life-threatening situations.

Conceptual basis

SE is based on the understanding that symptoms of trauma are the result of a dysregulation of the autonomic nervous system (ANS) whose inherent capacity to self-regulate is undermined by trauma. SE bases its approach on mammals' ability to automatically regulate survival responses from the primitive, non-verbal brain, mediated by the autonomic nervous system. In the wild, animals spontaneously "discharge" this excess energy once safe. Involuntary movements such as shaking, trembling and deep spontaneous breaths reset the ANS and restore equilibrium. SE restores this capacity to self-regulate by facilitating the release of energy and natural survival reactions stored during a traumatic event. According to founder Peter Levine, "Trauma lives in the body, not the event."

Practice

Sessions are normally done face to face, and involve a client tracking his or her own experience. Practitioners are often mental health practitioners such as social workers, psychologists, or psychotherapists, but may also be nurses, physicians, bodyworkers, physical therapists, clergy, or members of other professions. Certified practitioners complete a three year training course (216 hours of instruction) and must complete 18 hours of case consultations and 12 hours of personal sessions. SE is effective for Shock Trauma in the short term (typically one to six sessions) and Developmental Trauma as an adjunct to psychotherapy that may span years.

SE attempts to promote awareness and release physical tension that remains in the aftermath of trauma. This occurs when survival responses (which can take the form of orienting, fight, flight or "freeze") of the ANS are aroused, but are not fully discharged after the traumatic situation has passed.

SE involves a guided exploration of the physical dysregulation that is harbored in the body as a result of trauma. Sessions often do not focus on talking about traumatic experiences. Clients are educated about how the body regulates stress and learn to track the related physical sensations, feelings, thoughts and images that arise from traumatic memories.

Techniques include "titration" of the client's experience. Titration allows the client to experience small amounts of the event's distress at a time in order to release the stored energy and allow their nervous system to return to balance. The client is not retraumatized and can experience successful resolution.

Another element of SE therapy is "pendulation", the movement between regulation and dysregulation. The client is helped to move to a state where he or she is dysregulated (i.e. is aroused or frozen, demonstrated by physical symptoms such as pain or numbness) and then iteratively helped to return to a state of regulation. The goal is to allow the client to resolve the physical and mental difficulties caused by the trauma.

"Resources" are defined phenomenologically as anything that helps the client's autonomic nervous system return to a regulated state. This might be the memory of someone close to them who has helped them, a physical item that might ground them in the present moment, or other supportive elements that minimize distress. In the face of arousal, "discharge" is facilitated to allow the client's body to return to a regulated state. Discharge may be in the form of tears, a warm sensation, the ability to breathe easily again, or other releases of energy which demonstrate the ANS returning to its baseline. Through this process, the client's inherent capacity to self-regulate is restored.

Somatic Experiencing is useful for shock trauma and developmental trauma. Shock trauma is loosely defined as a single-episode traumatic event such as a car accident, natural disaster such as an earthquake, battlefield incident, physical attack, etc. Developmental trauma refers to various kinds of psychological damage that occur during child development when a child has insufficient attention from the primary caregivers, or an insufficiently nurturing relationship with the parent.