Douglas Smith



Elements of Somatic Therapy

Below is a brief primer on somatic therapy and  a “lexicon” of terms and phrases that can be used in working with the body.

Somatic therapy shifts the focus of psychotherapy from an emphasis on cognition and affect to a deeper inclusion of the body and the client’s experience of the body. It is the experience of the automaticity of the body and of the particular states that arise as somatic patterns that are the focus of somatic therapy.

Traditional psychotherapies seek to facilitate increased awareness of, and more conscious engagement with ingrained or conditioned patterns of experience and behavior. The recent expansion of mindfulness practices, body-oriented therapies, and advances in brain science and integrative medicine have helped clear the way for exploration of deeper somatic patterns – and have helped clarify their role in inhibiting or enhancing health and resilience.

It is becoming increasingly evident that the nervous and other body systems operate in a bi-directional manner. Feedback from the body, to itself, particularly from the viscera to the nervous system, is what manages the health and physiological state of the body. This knowledge allows us access to an expanded view of homeostasis. We can now practice and develop more “bottom up” as opposed to “top down” therapies.

The work of somatic therapy is to engage this bi-directional process from the body-feedback side — in essence, to bring the therapeutic conversation to the body. The key “tool” for this work is the cultivation of body awarenes, or interoception. Interoception, in the psychobiology sense, can be defined as:

“…the ability of visceral afferent information to either reach awareness and/or to directly or indirectly affect behavior.” (Cameron, 2002).

Obviously, for psychotherapeutic purposes we are interested in the form that reaches consciousness. My work in somatic psychotherapy has shown me that it is possible to enhance this natural interoceptive ability with the use of focused attention in the body. Somatically focused therapy provides a disciplined strategic process for gaining access to the body.

Below are the key elements of the cultivation of body awareness:

 Elements of Body Awareness

Interoception – The key to somatic therapy. Defined above.

Differentiation – The starting place for differentiation is what I call dual awareness, the recognition of two or more states of activation or settling in the body at the same time. This begins to build the capacity for more nuanced awareness of the body and of patterns of activation relative to mental and emotional states. A deeper way that somatic work uses differentiation is through awareness of “layers” of the body.

Tracking – Tracking is the mindful attention to sensation in the body, and following of changes and developments as they occur. In therapy the therapist can coach the client to follow sensation and encourage an attitude of curiosity. In this way patterns of reactivity or relationships between affective and somatic states can begin to become apparent. There will be a distinction between attention and intention in tracking. One is the holding and the other, moving of attention.

Titration – In medicine, titration is the gradual adjustment of a dose of medicine until the optimal result is reached. In somatic work, titration is the gradual introduction of awareness of a pattern of activation (usually sympathetic arousal) until the system can tolerate or “digest” the experience. The simplest example of this would be in trauma work where the gradual exposure to a traumatic memory and its accompanying activation results in an increased capacity of the body and mind to maintain equilibrium in the face of the energy inherent in the trauma pattern or structure that becomes activated.

Coherence – The tendency of systems to move toward balance and integration. This is both facilitated and looked for (tracked) in the body. Coherence exists in all realms. There is coherence of breath, coherence in tissues, coherence in relationship between systems and structure of the body. The reason that coherence is important in somatic therapy is that coherence begets coherence – if there is coherence in one system there is a tendency for systems near by to fall into coherence as well. Normally this will bring on settling in the body, and therefore parasympathetic down-regulation, which is a key goal in somatic therapy.

Resonance – or somatic resonance – is the client-therapist relationship on the somatic level. This is where your own embodiment practice meets the client in the therapeutic relationship. Looked at from one perspective, resonance can simply mean that you are consciously present as much as you can be with the client’s experience – and your own. Or it can mean that you are intentionally focused on one particular aspect of the client’s experience and bring (or find) yourself in sync with that.