The ‘somatic therapist’ nightmare

Increasingly, I am hearing disturbing stories from new patients about what is being labeled in the SF Bay Area as ‘somatic therapy’. What is clear is how many clinical and non-clinical people are calling themselves ‘somatic therapists’ and offering subpar to damaging services to individuals in need of effective mental health treatment for PTSD. 

Frankly, I have no idea what a somatic therapist is. Yet so many people are seeking somatic therapy because these days pop psychology views everything as traumatic and somatics as the cure for all trauma. This reminds me of what happened 15 years ago when mindfulness became the clinical intervention for every malady. We all know how poorly that worked out.

Integrative psychotherapy acknowledges that mental health is interdependently determined by the systemic quality of one’s mind states, emotions, and bodily responses. Human beings are organisms in constant flux; continually homeostatically reacting and responding to causes and conditions. Our thoughts are conditioned by body health as much as physical health is undermined by a chaotic mind and highly-reactive emotions.

Because traumatic experiences impact the entire human organism, resolving traumatic experiences must be a whole system endeavor. Changing thoughts is not enough. Loosening muscles and tissues will not prevent future bracing each time a challenging-enough situation occurs. And emotion regulation is a body-mind-heart mission.

Somatic Experiencing® (SE™) focuses on and accomplishes whole system trauma resolution. SE is a complex theoretical model delivered in a three-year training program. It takes time to learn how to recognize, work with, and deliver skills for effectively resolving the nervous system dysregulation commonly found in PTSD sufferers.

Other clinically helpful trauma methodologies include Sensorimotor Psychotherapy and EMDR. However, EMDR is often too activating and unhelpful for people with complex-PTSD who experienced early developmental trauma prior to adult traumatic events. SE is an excellent methodology for those individuals.

I encourage asking anyone claiming to be a ‘somatic therapist’ what training they have undergone and if they are a licensed clinical professional. Unlicensed practitioners are unregulated practitioners with no legal or ethical oversight. That is a minefield to avoid particularly for trauma sufferers.

World Mental Health Day

It seems dis-ease predominates the world stage at this time. Whether it is whiplash from 2.5 years of pandemic, the ongoing Russian war on Ukraine, or mounting climate disruption catastrophes, an air of dread permeates the current world mental health landscape.

In 2014 I coined the phrase genuine mental health and set out in a rather dense textbook to explicate what that might be and how to facilitate it in psychotherapy. I still hold to the premise that human minds are innately capable of humility, wisdom, compassion, and great insight. And I remain committed to offering patients targeted, clinically-appropriate contemplative practices for cultivating these states and building states into traits.

Eight years later the landscape of mental health interventions seems more murky, sensationalized, and as Yaden, Potash and Griffiths recently described in JAMA Psychiatry more subject to hype-cycles. Psychedelics and cannabis are big medical business now and clinical research on effectiveness is slower than business-led exaggerated claims of efficacy. Substances are remarkably unpredictable in how a given human will react. And with the growing number of cannabis-induced psychosis reports (that industry refuses to address) I remain skeptical of the long-term transformative capacity of these methods.

And it’s not just the interventions, diagnoses as well have expanded to include almost any form of human suffering—particularly PTSD or trauma. Difficult or painful human experience is not by definition traumatic. Prior disposition and level of cognitive-affective-physical disorganization in a receiver’s system usually determines if a given painful experience will be traumatic or not. A great example is discussed in my previous blog post on overcoupling. Humans are a tremendously adaptive and resilient species by nature. Most of us can withstand high levels of challenge and some of us greet it with joy and anticipation!

My prescription for World Mental Health Day is a plea for each of us to take up the mantle of humane, respectful conduct and communication in all of our interactions with others—regardless of whether they are friend, foe or stranger. Kindness is not enough. Holding in thought, word and deed a commitment to non-harming is critical in a world of increasing global disturbance.

Equally important is the compassionate recognition that every human has their own form of human suffering; me included. None of us is perfect. Reflecting on our own imperfection and recognizing the power every one of us has to awaken to genuine mental health, will rescue our world from its current path of intensified suffering and harm.

Uncoupling excitement from danger

Though this Somatic Experiencing® intervention is not discussed widely in SE™ circles, I consider it one of the most critical steps for resolving long-standing systemic trauma response. A history of early (0-6 years of age), repeated, traumatic experiences are easily identifiable in adult autonomic nervous system (ANS) dysregulation. The primary sign is minimal capacity for sympathetic nervous system (SNS) arousal.

SNS arousal is not bad nor it is an indication of something wrong. For instance, awe-inspiring, meaningful, interesting, or joyful experiences are arousing. The body needs SNS arousal to accomplish any activity that does not fall under the category of ‘rest and digest’ homeostatic function. Many forms of overcoupling are common in early developmental trauma (EDT) response—including overcoupling of SNS arousing states of excitement and danger.

To a very young brain, most experiences are novel. Inherent in novel experience is a quality of excitement. That means interest, exploration and play are often encoded in memories of EDT events that most adults would only consider frightening, egregious, and morally corrupt. Very young children don’t feel danger until they are directly threatened, disturbed, terrified, abandoned, or physically harmed.

This intermingling of novelty, excitement and danger can be difficult for adult survivors of EDT to accept–especially when memories are laden with disgust, shame, terror and anger. A good example of excitement/danger overcoupling is in sibling sexual abuse where a tween sibling frames perpetration on a much younger sibling as ‘play’. Initially the novelty and attention can register in the young victim’s brain as an exciting experience with no negative valence. Yet, that can shift to fear, confusion and resistance at any point during a particular perpetration event or with successive events. Overcoupling of excitement and danger increases with each successive perpetration. Eventually novelty and excitement fall away and what remains is high-dorsal vagal freeze—(a parasympathetic nervous system (PNS) safety response)—because small children can rarely run from or fight off an older perpetrator. Proliferation of successive events increases excitement/danger overcoupling in SNS dysfunction.

Obviously the first intervention is helping a patient conceptually understand excitement and danger overcoupling, and then facilitating increased capacity for presencing the body-mind system’s low threshold for excitatory body sensations, thoughts and feelings. That is the ideal time to introduce SE™ pendulation skills for initiating parasympathetic deactivation, which eventually actuates healthy SNS/PNS cycling.

I feel such joy when this work results in a patient report that includes something like, “This week I actually felt excited and just let it happen without worrying something bad would occur or I’d become so overwhelmed by good feelings. It is so freeing to not be scared of my emotions… even the good ones!”

In summary, early repeated traumatic experiences impede our natural capacity to tolerate systemic aliveness. Uncoupling excitement from danger allows the ANS to move more readily, willingly and easefully between SNS activation and PNS deactivation.