Somatic Talking... The Misunderstanding About Talk Therapy
“Get yourself a therapist who doesn’t just do talk therapy.”
I hear some version of this statement with uncomfortable frequency. As a therapist who has come to believe in the talking cure, this statement concerns me. I worry that people with trauma are being fed misinformation. This statement is minimizing what is actually possible in talk therapy while simultaneously ignoring that which is potentially problematic with somatic therapies.
I do not wish to write about this in a way that pits two camps of therapy against each other, but rather to dismantle some of the assumptions embedded in this opening statement. And yet, even writing this blog will likely activate those who have come to believe that helping people in moving trauma out of their bodies through mind-body techniques is a superior and necessary tool for treating trauma. Forgive me as I walk the line between advocating for the talking cure as an incredibly powerful tool in treating trauma and believing that somatic interventions can be helpful too.
Forgive me further as I bring light to the reasons that I choose to rarely use somatic tools in my work with patients. I do know that somatic interventions have their place and their immense benefits. I am primarily concerned with the idea that somatic interventions are currently being touted as the treatment of choice—the best treatment for trauma. There are very strong reasons why it is sometimes NOT best and how somatic practitioners who do not consider these issues might do more harm than help.
So first, let me define somatic therapy. Somatic therapy is broadly defined as a treatment course that uses mind-body techniques to help people to release or move through trauma stored in the body. The goal is to teach and guide patients in using their bodies and mind together to begin to calm the dysregulated nervous system. Those who practice somatically often reference books like “The Body Keeps Score”. Practitioners of these therapies harness the vast research on how the body stores trauma and how movement can release that trauma in a way that regulates our nervous system. In theory, this approach makes good sense, and one might ask why anyone would be so archaic as to ignore this research and not implement it in their work.
Which is why we see statements like the one I started this blog with.
So let me explain why I have made that choice.
First, I will advocate for the talking cure. One person told me recently “You cannot talk your way out of a dysregulated nervous system”. This is the first and most significant error that one makes when thinking about talk therapy. Here I offer a thought exercise. Imagine the person you trust most in life. The person you feel you can say anything to. Now imagine the last time you spent time with them, and they really listened. In fact, they let you talk the whole time about what’s been on your mind, what you’ve been afraid to say out loud, what you’re afraid of, what you’re excited about. Now imagine what that did to your nervous system. Now imagine if you knew you had that available to you weekly. Most of my patients report that talking weekly in therapy is one of the most grounding and regulating things they do. And I think this thought experiment helps one understand why.
“We need to look beyond Western Medicine to find answers to the trauma stored in our bodies” is another statement I’ve heard. Another misunderstanding of talk therapy. When a community comes together in prayer they are talking. When tribal members sing and wail in ceremony it is a version of talking. When one prays before dinner and bedtime, they are talking. When one confesses to their priest, they are talking. Talking in relationship and being able to say anything to someone (even if it’s God) is not western medicine. It is a deeply essential part of being human. Cultures have known that talking cures far before Freud called it psychoanalysis!
“Talking is a cognitive activity”. This is completely incorrect. When one is providing CBT it may very well be more of a cognitive activity (although I don’t think any activity in relationship with another person is purely cognitive). In psychoanalysis, it is certainly not purely cognitive. Trauma is indeed stored in the body. It is stored most intensely in the lower levels of our brain where it is meant to be held to keep us safe. The lowest levels of our brain are those that deal with all trauma responses and emotional flooding. The lowest levels of our brain are the ones shooting out the chemicals that wreak havoc on the rest of our bodies. It is the starting point. Talking is a vehicle that connects that lower traumatized brain to the higher levels of the brain that can make sense of it all and thereby calm the lower levels down. It is like yoga for the brain—and the brain is a big part of the body. Somo=body. How can exercising the third largest organ of the body (the brain) with words not be considered somatic?
We also know from neuroscience that talking actually re-wires the brain (for more on this I recommend Lucy Holmes ‘Wrestling with Destiny’). Talking IS somatic. It is a somatic experience to walk into my waiting room. To smell the scents, to look at the pictures, to sink into the rocking chairs while waiting. To listen to the sound machine quietly soothing the system, to observe the plants in the waiting room. It is somatic to sit on my couch and sometimes even lie down. It is somatic to use your lips, and your breath to form words. It is somatic to sit in a room with someone you trust. It is somatic to hear their soothing loving voice. Talking while in the safety of another person does a similar thing to the brain that moving while talking does. Instead of the movement being the calming factor... the relationship is. And I strongly believe that we only truly heal relational trauma through relationship.
This brings me to my concerns about the blanket statement that somatic therapy is the gold standard for trauma. First and foremost, somatic therapy often does not consider the relational impact of their techniques before suggesting them or directing clients to do them. Some relational impacts that I’ve seen are below:
1. “I am a person with trauma who is confused about who to trust and how to respond to people in power when they ask me to do something that is vulnerable. My tendency is to people please so if the person says this is the treatment that will help my trauma and they ask me to move my body to do so I will say yes because they know best. That’s what my trauma taught me to do. I am uncomfortable with what the therapist is asking but I think I should go along with it. Like the way I thought I should go along with my loved one sexually abusing me.”
2. “I believe I am broken and need to be healed by someone else. I am happy to have this person guide me on how I should calm my nervous system. But it’s not working. Maybe I’m doing something wrong. Maybe I’m broken beyond repair. Can I tell this person that this feels awkward and makes me feel more exposed and stressed? If it is working, can I keep it up if this person isn’t guiding me the whole time? I can’t really trust myself so it’s good that this person is telling me what to do. I’m not trustworthy enough to know my own body and find movement that helps calm my system down. If it should work for other people, it should work for me. I am a failure at therapy and will never get well.”
3. “I am not getting better so my therapist is referring me to something else. I am probably broken beyond repair and too much for anyone to hold.”
4. “I am deeply ashamed of my propensity to become over activated. I imagine most people find me unlovable because of this way that I am. My therapist is also someone who would be overwhelmed by my intense activation and needs me to calm down, so she/he doesn’t have to sit with my big feelings.”
I have come to believe in the Modern Analytic concept of following the contact functioning. What that means, ultimately, is that a patient will let you know how they feel best communicating and being communicated with. They will tell you what they feel ready to talk about and say anything about. They will let you know when they are ready for certain interventions and that, as clinicians, we follow their lead. This is a parallel to what one would experience in a healthy attachment relationship with a parent. The parent does not force milk in a child’s mouth when they need a cuddle. This is a way to provide attunement in the treatment relationship and it is very regulating and reparative. We follow their lead...not the other way around. I believe THIS to be the ultimate treatment for trauma.
Here are the relational messages I am aiming to send by “just” doing talk therapy with my patients.
“You are accepted as is and there is no rush on your progress. I want you to be here so that I can help you know yourself and I can get to know you. That is all.”
“I can hold all your feelings and feel them with you. I don’t need you to calm down or feel better. We can feel these feelings together and I won’t break under the pressure which means you don’t have to either. I am not afraid of or disgusted by your intense feelings and am not wanting to get rid of them just to ease my own nervous system.”
“You can talk about anything and almost nothing (only a risk to yourself, someone else or me) will get me to boot you to another therapist because you are too much for me. I can take your ugly parts even when they are directed at me.”
“I believe you know yourself better than anyone and I am here to build your sense of trust in yourself.”
“I will never ask you to use your body in ways that might cause you uncomfortable feelings in our work together and I will never use my body with you in treatment. You are safe from my intervention.”
“I will help you to brainstorm ways that can work for you—including somatic tools, but honor if you can’t do what is best for you right now. I will understand that your trauma makes it difficult to do anything other than what you’ve learned to survive, even if you have insight into what can help. I will sit with you for years as you say the same thing over and over again because I believe that once your nervous system is sufficiently calmed by our relationship and the talking, doing what’s best for you will be automatic.”
In my practice I do talk to my patients about moving their bodies in order to move through the chemicals of stress and the trauma pent up in their bodies. But I also follow the contact functioning when they make it clear that there is a block to moving their bodies. Because if I push for them to do something they are blocked in doing they will feel shame and assume I am disappointed in them. I honor resistance as a psyche’s wisdom on how to protect itself. I do not require of my patients that they move their bodies to be doing treatment with me.
So, before we stand so strong on the idea that somatic therapies are the gold standard for trauma treatment, please consider the nuance involved. There are huge blind spots we have accrued as a profession trained to fix people instead of loving them into health.