Somatic Work

This article demonstrates additional ways to work with somatic experiences rather than bridging to earlier-life traumatic memories that shaped the physical or physiological response. Most emotional experiences come with both physical and physiological sensations or responses. And theses somatic components are discrete and unique - we have a comparable experience each time the same psychological experience is activated (the same memory, or memories associate with a certain type of psychosocial experience or external trigger).

History of Previous Somatic Work

Many perspectives in psychological literature hold the mind-body connection with great importance. Freud posits in his psychosexual stages that psychological development and hold-ups are tied directly to developmental stages that relate directly to specific parts of the body, such as oral while breastfeeding, anal while potty training, and phallic when we might be becoming aware of sexual impulses.

Alfred Adler's whole perspective on personality was tied to hurdles we experience in our physical health.

Gestalt therapy saw mind and body as innately connected: when we have a psychological symptom, it correlates to a specific part of the body. Our dominant hand might be psychologically associated with the male parent (of course this is culturally bound). When we are focus on others' opinions, we "give up our eyes." When we don't speak up, we "give up our voice." You can guess that "standing up for yourself" would relate to having a firm sense of foundation in our legs, and our identity might relate to our core. We see these symptoms present physically - an issue with our core may result in slouching in the therapy chair.

While less focused on the meaning of connect to our psychology of the somatic experience, CBT focuses exposure therapies on tolerating physical sensations. Breathing through a straw to desensitize to the shallow breathing of panic, or spinning to desensitize to the dizziness. A major component of eating disorder treatment is exposure to sense of fullness as the stomach expands back to a normal capacity.

In my work in the inpatient hospital setting, it was common to see non-epileptic convulsive episodes, previously referred to a psychogenic seizures. This type of presentation could be considered a conversion disorder and possibly conceptualized as related to classic perspectives on histrionic character. Defensively, an unwanted, unmanageable, or unacceptable emotional experiences or Id urge is repressed (pushed out of conscious awareness) and displaced onto a bodily experience. In terms of thermodynamic physics analogies, a pressure pushed down must be released but also entropy occurs - information isn't lost but obscured: we can no longer easily connect the symptom to the psychological distress, trigger or original traumata (the work in therapy could be defined as reversing this entropy). In terms of brief therapy, these presentations typically respond to the same treatment as panic attacks, and I conceptualize them essentially as such, but also require additional validation as people frequently want or assume these symptoms should be addressed medically (and have been invalidated when told it is not medical). Additionally, the interpersonally instrumental component is typically more stark than panic disorder: these episodes frequently occurred when a patient wanted assistance with something they could and should do on their own.

Recent Trends: Brainspotting and Somatic Experiencing

We have seen a recent increase in somatic therapy modalities. A critique might be that these are all re-branding of existing therapies, even going so far as to question whether the originator did their homework and was familiar this approach already existed, or that some people like to have their name on something. However, I also think each one does have something unique to offer - I don't personally have much of a qualm whether people write about it as an adjunct to an existing therapy or call it their own. Readers can probably tell from my writing, I tend to see my approach to therapy as a take on, extension of, adjunct to, or perspective on an already existing modality rather than as something novel. Some new approaches are called Somatic Experiencing and Brainspotting.

While I only consider myself moderately familiar with these newly coined modalities, a brief background on brainspotting is that it stemmed from EMDR. A client continually became stuck in one specific gaze rather than shifting eye-sight, and this seemed to latch onto a specific traumatic or unprocessed emotional experiences. When our eyes lock into a particular region/gaze, we may also get a sensation that a particular part or region of our brain (sub-cortical region, supposedly) is activated. In other words, there is a somatic experience associated with it, as if the trauma, memory or latent emotion resides in that spot in our mind (brain). By identifying this and sitting with it, it allows the emotion to open up or be re-accessed and thereby processed.

Somatic experiencing holds some similar assumptions: that motor responses are held in our body somatically as a pent-up energy that needs to be released by identifying, acknowledging and opening up that sensory and motor experience behind the somatic symptom.

Approach in Therapy

I believe it was in a Frankl Logotherapy book that a metaphor was used in which an 3-dimensional item was hung from the ceiling of a dark room, and a flashlight was used to cast a shadow of the item. Depending on the angle of the light, the shape of the shadow might differ. For example, imagine a milk carton. One side looks like a rectangle, the bottom a square, another side looks almost like a house with a roof. If only shown one of these angles, we make a faulty assumption about the object. When shown all the angles, we can extrapolate much more accurately what the object is. Frequently psychology involves the same: multiple perspectives of something abstract and phenomenological, not often something so tangible, and by taking multiple angles - such as my article on conceptual perspectives - we can get a much stronger idea of what we are working with.

Likewise, we can take multiple approaches to somatic work. My previous article focused on bridging from the somatic to abreaction regarding earlier life trauma. However, I associate much of my somatic work in session with Gestalt therapy, emotion-focused therapy, and meaning making (existential). I might start by asking questions like "where do you feel it in your body?" We might heighten that sensation, "can you focus on it and let it grow?" And ensure we are getting the depth, "does it go deeper in your body?" just as we want to ensure we aren't just focusing on the surface-level of a verbal psychological experience (we think of these things are directly analogous).

At this point, we can move onto more detailed work with the sensation. Similar to Somatic Experiencing, the sensation may motivate a movement: "does the feeling make you want to move in any sort of way? Can you let it or act it out?" Frequently, we can glean meaning from the sensation by giving it a voice: "if you had to turn that feeling into a sentence, what would it be? What does it say?"

These sensations are often experienced as if they are imposed by external forces. Colloquially, we have heard sayings like "an elephant on my chest." Frequently, clients can use imagery to describe what might be inflicting this sensory experience. Pressure on the chest might, to one client, feel like a boulder (stress or pressure), a punch (fear of attack or loss like "a punch to the gut"), or a shield (preemptive defensiveness). Client's can often go into great detail about this, and begin a narrative about why they might need the shield, what it feels like to them, what would it be like to set it down, maybe ambivalence about having to hold this heavy yet soothing chunk of metal.

I recall a client who was frequently unresponsive during an inpatient hospitalization and reported being stuck in their chair. This elicited strong countertransference from other care providers who felt it was obstinate. The client imagined what they were sitting on, what it felt like and the sense it gave them: in contrast to feeling stuck, it also felt secure and safe. They recalled feeling unsafe as a child at recess (due to bullying) and hiding behind a tree that had roots like the knee of a parent - a parent they felt they never had at home. This tree came to be a surrogate for this, though ashamed to admit they sought this type of comfort from an inanimate objects, we validated the tenacity in getting this need for an adequate parent met. The client went on to write short-stories about adventures shared between herself and this tree (and the above described shield she carried to protect her chest). She was no longer unresponsive and stuck in the chair through the rest of the hospitalization, breaking the cycle in which her symptom and subsequent behavior (locked in chair) elicited via projective identification a repetition compulsion in which current caregivers (at the hospital) acted like past ones (parents and teachers invalidating when she complained of bullying from peers).

If we refer back to the article on cognitive styles, we can recall that people tend toward one side or the other of the continuum - intellectual vs emotional. Mental imagery and metaphor are powerful tools in psychology because they innately involve integration (alliteration not intended) of thought, memory and emotion into a meaningful representation, that, as the saying goes [a picture] is worth a 1,000 words. These images often provide a lot of meaning, and are also easily elicited during times of distress, more-so than recollection of a coping skill repertoire, so they can have powerful impacts on safety. I tend to think of these images in the Jungian sense of a symbol - a sort of collective unconscious archetype that holds both innately human (collective) meaning and individual meaning to the client.

Submodality Therapy

Submodality Therapy is an offshoot of Neurolinguistic Programming (NLP), a theory developing in the 1970's. NLP was created by academics including a mathematician who came to recognize we actually take in and process a fraction of the data (bits of information) present in our environment, AND at each step of processing, it is filtered through or altered by the lens of our personality and past experiences. In other words, our experience is more subjective than objective. This gives rise the possibility of intentionally altering our experience on a subconscious level. Consequently, NLP and submodality therapy are often associated with or discussed in relation to hypnosis: while it doesn't require a trance state, it arguably comparably targets our unconscious.

An example could be pain treatment. Let's identify the pain and see if we can imagine the color we associate or experience with it. Is there a color that would be less painful? Can we replace, in our mind, the original color of the pain with another less painful color? Maybe we can also adjust the intensity, brightness or opacity of the color. The color and other factors of the pain's visual representation are submodalities. Submodalities could involve any of the 5 senses, and changing one could significantly reduce the pain. Another approach could be changing our perspectives - while I don't typically associate this with NLP in my work as a therapist, I frequently use the following analogy:

Imagine an elephant sitting in this therapy office with us. It would take up all the space. All we could see and smell would be elephant. Now, let's imagine the same elephant, but at the goal post in the Steeler's stadium. And we are sitting in the nosebleeds behind the oppose goal post. Same problem. Same size problem. But it isn't our entire world.

Being mindful and distancing from the pain or problem gives us perspective and allows us to focus on other things. I recall a client who likely had dependent traits, an adult living with his mother, having significant difficulty differentiating and finding a consistent career. He felt like he lacked agency not only in the world, but is own psychological experience. The client had a lot of physical and emotional insecurity related to his foley-bag. During a session, we discussed his sense of puzzle pieces whizzing around his head and right in front of his eyes - these were his thoughts and psychological issues. We imagined zooming out, taking a step back, and seeing from a distance - sure, it might still be a confusing, dizzying whir of parts, but now we have perspective. He came back the next week excited he felt much more focused, as if he was able to reach out and grab one puzzle pieces from the array of whirring pieces, and focus on it alone. He had identified discrete problems to focus on that we talked through in following sessions.

Parts Work

Most people have inner dialogue or self-talk. Sometimes we think of this as an angel and/or devil on our shoulder. We might recognize a specific origin for these parts, as if we are imagining talking to our parent, or hear the voice of a mentor when making a decision (this is a common phenomenon in psychology). It can be a useful therapeutic tool to encourage internalization of our (therapists) voice as an inner structure to lean outside of session: "in therapy, you start by coming into the office, sometimes leaving some things here for latter, but you end up taking this office away inside yourself."

Parts might also be less obvious - automatic thoughts as we call them in CBT. Harsh self-talk that we've so strongly introjected and identified with that it seems just like our own mind. We may have to do some work to identify and differentiate it. What are the things you feel in your body when this happens? What kinds of things trigger this? What is the nature of that voice - the words, tone, timbre (how it sounds)? If that were a real person in this room with us right now, can you describe them - what would they look like, sound like, their posture and clothes, their age? Does it remind you of anyone?

Likewise, I will point out the changes in my client as these parts present. The change in posture, tone, facial expression, and body language. We can explore what each of those somatic experiences mean. For example, they might hunch over and cross their legs - losing their core and foundation - in the presence of an internalized harsh and critical parent. They perceived the parent as lurching over them, wagging a finger. What if we changed their body language? What if we do 2-chair or empty chair experiments (Gestalt interventions) with this part? Frequently clients come to understand this part of fearful and trying to control them out of fear, but even further, it isn't truly their parent, but a frozen part of themselves acting like a parent - ironically, this part of themselves is younger (obviously) than they are now, but it begs the question why they see it as powerful and hovering over top of them? The image starts to change - it is a fearful younger self than a powerful critic.

Here we can imagine integrating parts work with submodality work. What if we imagine the part appearing differently, actively rather than passively allowing it to change through therapy? An IFS therapist might see this as a telling error, but my experience is that it has utility when a client struggles to see their harsh internal critic differently. What if we imagined a different voice? What if their stature was absurdly tiny? Can we imagine them inside a TV screen rather than on or over your shoulder - does the distance make them quixotic? Can we imagine turning down the volume one notch a time? I frequently use the metaphor of a sound system with two volume knobs: one for the critic and one for the healthy adult self they have inside them. This is a mental image of the psychodynamic notion of cathexis: to energize a psychological part. The goal isn't to excise any one part of our self, but to change the way we related to it: to put our healthy, core, adult self in the driver's seat and treat the others as, say, royal advisors.