Somatic Psychotherapy

Somatic psychotherapy.


Mindfulness has made a big impact in our society and psychological field these past years. Many clinicians have incorporated mindfulness into their modalities. When mindfulness is used, the client is referencing their somatic awareness, how they “feel” inside. But often there is lack of follow-up on how to facilitate the somatic feelings into a coherent experience. In short, clients learn to get mindful, but not how to journey into the somatic experience safely. This is critical when working with trauma and stress.


we can afford to cross pollinate and learn from various therapy disciplines so we can benefit our clients.


The Cartesian split of the body-mind is alive and well in our dominant culture. We “think” that we can overcome problems with cognitive reasoning alone. Western psychology has a bias towards mind over body, rather than a trust of the body’s intelligence. Feelings and sensations have been marginalized when connected with body awareness. This may play a role in why somatic techniques have not yet been widely integrated into mainstream psychotherapy. Yet, the holistic awareness of body-mind is critical in any healing of mental ailments and physical challenges our clients face.


In each trauma client I have met there is both a dread of trauma symptoms and a deep desire to come back to a holistic sense of self. This desire is a deep knowing from the body that there is a pathway back to health. That sense is somatic awareness.


A high percentage of PTSD and stress disorder clients suffer from somatic complaints and the inclusion of the body is a big factor in trauma memory recovery and the healing of trauma symptoms. I highlight the importance of somatically resourcing the client and techniques to aid this, as this is a central tenet of the somatic trauma work.


Interoception is the capacity to feel one’s present body through emotions, sensations and different body states. Feelings and emotions are often understood as interchangeable. They are interconnected, but distinct. Emotions are lower level and sensory-based responses such as biochemical changes of the brain. Feelings begin in the neo-cortical regions of the brain and are important for our memory consolidation. Emotions begin before our feelings. Emotions are primal, direct and physical. Dr. Antonio Damasio calls feelings “mental experiences of body states which arise as the brain interprets emotions.”


Insert The Secret Life of the Brain quotes about Sentencing people after Lunch


This coupling of emotions-sensations-memories is often what we encounter when clients get stuck in traumatic memory or haunting images.


(MEMORIES AND TRAUMA _LEVINE??)


The other ability is the proprioceptive sense. This self-awareness is experienced through the movement of the body. We discover where we are in time and space through our proprioception.


(P-DTR INSERTIONS)


The interplay of interoception and proprioception through the nerve and spinal pathways of body and brain integrate into one cohesive awareness of the body. This integration is felt through emotions and sensations.


A person’s thoughts, feelings, sensations, attitude and belief systems all have an impact on the physical well-being of that person. How is the person experiencing themselves in the various categories of their existence? What do they believe about themselves? And where are these beliefs narrow or limiting to the degree that they impact physical and emotional well-being?


(Insert the logical levels of identity and plausibility, the five levels of attachment and the BioPsychosocial model of pain)


Somatic psychotherapy is highly effective with trauma-associated symptoms because these are often experienced very physically in the body.


(Insert story about sensation of pain, decreased range of motion, in class of teaching with assault)


Many people don’t have a daily, regular practice of coming back to their bodies. We sense and feel through our bodies every minute of the day, yet we seldom become aware that we are doing this. Only when tensions or pain in the body arise do we pay attention to what is happening.


(Insert QOUTE about pain being protective like a fire alarm or a child crying, do give the baby pills, booze, ignore it, beat it up?, why do we do this to ourselves)


perceptions of the body are driven by our exteroception (a sensitivity to a stimuli that originates outside of your body) and interoception (a sensitivity to a stimuli originating inside of your body).


Embodiment is feeling oneself directly, without the constant narration or interpretation of our thinking mind. This embodiment has no judgment, no commentary from an inner belief, and no filters, but rather presents the raw data of the body “as is.” We can call this present-moment body awareness—direct communication from our deeper self or embodiment. This is a moment in which we are not bound by past or future, and can live in the present moment.


suggest, explain and then follow up with the results. Explaining ahead what the exercise or practice is makes it safe and accessible for the client.


“Would you like to try an experiment?”




Seven Body Wisdom Principles


1. The body responds to external environment with constriction, blockage, muscle tension or unbalance, and acts in unhealthy habits when stressed, physiologically or emotionally threatened, or misused.


2. The body remembers implicitly feelings, sensations and memories when vulnerable, emotional, triggered or touched.


3. The body changes all the time. It’s flexible and moldable.


4. The body’s experience is transient and does not last. Even pain will subside.


5. The body is capable of repair and healing at any time.


6. The body’s wisdom comes forth when attended to, or related to, with kindness, curiosity and patience.


7. The body is the most important place for healing and transformation.



UNDERSTANDING BODY SYMPTOMS

The body expresses itself through the landscape of feelings, sensations and tensions. That’s why understanding and correctly assessing for body symptoms, or cues, is the key in successfully delivering somatic techniques.


For example, you might hear a client say, “I have a tight shoulder because I slept wrong,” and brush this off as the truth. But through the somatic lense, you can see this as a cue of the body to be discovered. A simple, “Let’s pay attention to that shoulder right now. See what you can sense or feel as you slow down,” can bring forth a meaningful and increased level of body awareness.



Often, clients will voice their discontentment of other approaches they have tried and have had limited success with.


Statements such as, “Talk therapy has been helpful, but has not resolved any of my physical complaints,” or “Nothing is changing my patterns, my relationships, or how I am with myself,” are common.


In my own practice, I have typically worked with three types of clients.


The first are ones who are informed about somatic work and want to try it; the second are those who are referred because of their “unexplainable” somatic symptoms; and the third are trauma clients who are stuck in their memory resolution or strong trauma symptoms.


I offer complimentary care for those clients who are not seeing their symptoms resolved through traditional talk therapy or biomedical care.

It is important that somatic complaints are checked out by a medical professional, as a combination of medical attention and somatic therapy offers the best solution.


Clients who can’t be mindful and follow their inner awareness are not good candidates for somatic interventions. a basic human curiosity needs to be present before proceeding with these interventions. For example, a client struggling with body dissociations as a result of severe body trauma or body image issues, might not be ready to inquire into their body experience yet. If paying attention to the body feels too overwhelming or more anxiety producing, that would be a good indicator that somatic interventions are not right.


Since working with body awareness can be new and can potentially bring up feelings of shame, discomfort, and trauma responses, you want to approach any body techniques with an open and respectful attitude.


“How does your body know that?”


Somatic interventions only work if there is collaboration, curiosity, and an experiential mindset to learning


Support the client’s wisdom of their experience and process. This approach requires the experiential mindset of you, the therapist. Don’t take rejection personally; be open and curious, even if an intervention does not work. The more present-moment focused you are, the more you will see what needs to happen, rather than what you think should happen. In this way, you can really listen to what the client is sharing about their body.


1. Ask more about HOW an experience is feeling

2. Encourage curiosity more than solutions

• “How are you noticing these feelings?”

• “Where are you sensing…?”

• “How are you experiencing this right now?”

• “As you are feeling this…what do you notice?”

• “How does the body experience of______appear to you in this moment?”

• “What are you curious about…now?”

• “What do you need right now to stay with this…?”



Burnout

AKA compassion fatigue can be associated with working closely with trauma and stress clients. In addition to the traditional burnout signs, this exercise lets you evaluate your burnout level from the inside-out.


Burnout is usually defined as a condition where the healthcare provider becomes emotionally and physically exhausted due to the job they are performing. These signs can be detected by paying attention to how the body responds.


Allow 20-30 minutes to go through this assessment.


This is not just a list to check off, but an exercise to tune into your level of burnout distress on a somatic level.


☐ Isolation from others

☐ Excessive blaming, feeling resentful

☐ Easily overwhelmed

☐ Stuck emotions that you are unable to express

☐ Irritability, tendency towards aggressive outbursts

☐ Frequent troubles with others, misunderstandings

☐ Compulsive behaviors

☐ Lack of self-care

☐ Nightmares, flashbacks of clients’ stories or own trauma history

☐ Chronic physical ailments (gut health)

☐ Apathy towards life events, friends and work

☐ Difficulty concentrating

☐ Mentally and physically tired

☐ Preoccupied, or urge to distract (high use of media)

☐ In denial about problem

☐ Reluctant for change

☐ Lack of flexibility

☐ Lack of future vision

☐ Legal problems and indebtedness

☐ General negativity and depression

☐ Inability to complete tasks, feeling ineffective

☐ Somatic complaints that can’t be explained (headaches, stomachaches, digestive issues)

☐ Lack of physical drive and energy


ANTIDOTE TO BURNOUT


• Kindness towards self

• Admitting the burnout problem and taking small actions towards health

• Compassionate body awareness

• Mindfulness moment and practices

• Awareness of the problem—admit the issue to self

• Sleep/Self-care

• Accept being on the path of recovery

• Listen to others who suffer

• Clarify boundaries for yourself of what works and what does not work

• Express your needs towards yourself first, then to others

• Get therapeutic help, or consult with people familiar with this issue

• Engage the physical body with somatic techniques and actions

• Take positive actions in your life

• Make a realistic plan and take small steps towards change that are sustainable


INSTRUCTIONS


Take a look at the previous list of symptoms.

Do you recognize yourself?

Check off the symptoms that apply to you.

Notice your response to the list:

Overwhelmed? Not sure where to start? Let’s start with the body.

• Sit or lay down. Tune into your body. Close your eyes, feel your breath, take a moment to slow down first. One step at a time.

• Visualize one situation of burnout or compassion fatigue. You can call up a client that is draining or a session where you have felt disconnected or impatient to start sensing into the somatic experience of the burnout. What comes up?

• Now, tune into your body. Can you feel your body? What exactly do you sense in your body?

• Notice the source of agitation on a physical level. Let go of the story or the reason. Just focus on the body. Where is the location of agitation in the body?

• Now, tune into your body. Can you feel your body? What exactly do you sense in your body?

• Notice the source of agitation on a physical level. Let go of the story or the reason. Just focus on the body. Where is the location of agitation in the body right now?

• Make a quick body drawing to indicate where this agitation is located.

• Now imagine what the agitation is and what your body needs right now. Write down three qualities your body needs to overcome the agitation:

1. ___________________________________________________

2. ___________________________________________________

3. ___________________________________________________

• Become quiet and see yourself applying these qualities. You can visualize, or move your body, bringing breath awareness to it. Notice what changes. Write down one positive statement of the change you noticed, or make a drawing of your body now.



When Working Somaticly.


Rather than “why,” ask: How, where, what is that like for you?

Don’t ask for answers, ask for inquiry.


Here are some inquiry questions that can be helpful:


• What quality does it have? What kind of joy, anger, sadness, etc., is it that you are feeling towards him/her?

• What is the texture? How do you notice this change right now?

• Where is the location? Where do you feel that tightening in your body?

• How is it? Compare: Is it trying to hold something in or let something out? Is it stronger on the right or left side? (Note that the answer to this second question is probably irrelevant, yet it serves to guide a person more deeply inside.)

• What kind of movement? What kind of movement goes with that feeling?

• Where is the impulse? What impulses are connected with this anger, sadness,

• Notice what memory: What does this feeling in the body (joy, anger, sadness, etc.) make you remember?

• What kind of words? What words go with this experience right now?

• What kind of meaning? If your fingers were talking right now, what might they be trying to say?


The language of the body is not to be revealed in questions, but in an open, warm and curious manner.


These empathic statements reflect and invite the client to open up to their own experience. Sample empathic statements:

• “You seem ____(sad, angry, anxious, etc.).”

• “You have a lot going on right now…”

• “There appears to be quite a lot of ____(emotions, sensation, thoughts, feelings) with…”

• “So, there is a lot of ____(energy, movement, etc.) right there…”

• “That can be hard to figure out…”

• “There’s something curious about this right now…” • “It seems like a lot of ____(emotions, thoughts, etc.) with…”

• “I sense that something challenging is coming up…”

• “That would be pretty upsetting…”

• “So, the sensation is moving right now…”

• “You are noticing the…”

• “That is painful for you…”

• “Ah, that makes you angry…”

• “What kind of (sadness, fear, confusion, numbness) is here?”

• “How deep does that tension go?”

• “Is there a texture that goes with that?” (E.g., emptiness, tiredness, constriction.)

• “Is there something familiar about this?” (E.g., tingling, intensity, weariness.)

• “Is there an image that goes with that?”

• “If this _______________had a color, what would it be?”

• “What sound would this _______________make?”

• “What is on the other side (behind, all around, underneath) it?”

• “What’s happening in the rest of your body?”

• “How comfortable/uncomfortable/pleasurable is it?”


Simple formula to connect and deepen the current experience:

1. Tune in (to present experience)

2. Stay (with present moment)

3. Explore (what is)

4. Notice (what has changed)

5. Reflect (on what’s new, different or has meaning)



• “Get curious about …”

• “Allow yourself to turn toward your experience right now.” (You can say “pain,” “anxiety,” “heaviness,” etc.)

• “What happens inside you when you say that?”

• “How do you experience that in your body?”

• “Go ahead and stay with this…”

• “Just notice your experience right now…”

• “Stay with that.”

• “Stay with the ______________and see where it takes you.”

• “See what the ______________knows…”


Tune in… Stay with… Explore… Notice… Reflect…


WHAT ELSE

Facilitating a somatic unfolding means we need to follow the organic process. After you feel into the present-moment experience with mindfulness and body awareness, ask the question: What else? This is NOT to get an answer, but to facilitate an opening into the somatic present-moment experience. Ask this question, then see; ask again and see again. Notice what comes up. Where is your attention? What do you notice? Images? Feelings? Insight?


(Insert THE COACHING HABIT FOUR QUESTIONS)


Tracking

is a term borrowed from the animal world. When we track the imprints of animals, we can make educated guesses about them. By noticing the depth of an animal imprint, for example, an experienced tracker can estimate the weight and perhaps the mood of the animal, such as if it was hurried or on the run. Based on clues the animal left behind, a tracker can make a close guess about the life of this animal.


(Insert Ishmael story about story)


This metaphor extends to us tracking body cues. Noticing a calm and steady eye contact might indicate a curious and open engagement. On the other hand, a hurried look that is vigilant could perhaps indicate an internal state of fear. By tracking/noticing these cues, the therapist has an indication of what is happening for the client. This information can then help a therapist be more effective and accurate in offering therapeutic interventions.


There are five types of tracking:


1. Tracking the content—how the story is being told.

2. Tracking the body’s expressions and cues.

3. Tracking the autonomic nervous system cues.

4. Tracking the meaning behind the narrative.

5. Tracking what is not being said (the non-verbal story).


(INSERT DEB ABOUT POLYVAGAL in THErapy)


• How does that client present himself or herself to you?

• What is the official story?

• What is not being said?

• What is the meaning behind the story?

• What is congruent?

• What is incongruent?

• What is the body telling AS the client recounts their story?

• How is the body non-verbally responding? Breath, movement, speech pattern etc?


Tracking for trauma cues is the best indication that your client is getting emotionally overwhelmed, agitated, or beginning to freeze and dissociate.


HYPER-AROUSAL CUES

EYES

☐ Eyes widening (as if in shock)

☐ Eyes searching and scanning (vigilance)

☐ Eye contact direct and threatening

☐ Eye contact sustained with conflicting emotions (staring)

☐ Eye contact with confused look

SKIN

☐ Skin flushed

☐ Sweat pearls on forehead

☐ Tingling sensations on skin (reports pins and needles)

☐ Skin appears patchy (red blotches on neck and chest and parts of face)

☐ Client self-reports hot, itchy skin

EMOTIONS

☐ Anger flashes and irritation

☐ Crying easily

☐ Emotional affect high and quickly aroused

☐ Jumpy, jittery, looks nervous

☐ Vigilant to every sound in the room

☐ Vigilant to every movement in the room

BODY

☐ Reporting inner heat rising in the body

☐ Clammy hands and sweating

☐ Body movement erratic or abrupt (motor functioning impaired)

☐ Reports stomach flutters (butterflies)

☐ Reports taste changes (for example: metal)

☐ Ringing in ears (or tinnitus gets stronger)

☐ Various muscle tensions (shoulders, belly, arms, hands, legs)

☐ Body contorts into involuntary leaning postures and twists

MIND

☐ Memory loss/gaps

☐ Mind races and reports lots of details

☐ Attention is hyper-focused

☐ Reports intrusive memories or imagery



HYPO-AROUSAL CUES

EYES

☐ Eyes dull and withdrawn

☐ Eyes have a blank, fixed stare

☐ Eyes rolling back into head

☐ Eyes have a vigilance that is hidden (takes peeks, afraid to look)

☐ Eye contact quality is disrupted, can’t sustain, or sustains for a long time

SKIN

☐ Skin gets pale (lifeless quality)

☐ Client self-reports cold skin

☐ Cold sweat

☐ Client self-reports tightness

EMOTION

☐ Numbness of feelings/sensations

☐ Flat affect

☐ Feelings are disconnected from body (reports cut off in body)

☐ Can’t report sensation, jumps to meaning-making and analyzing

☐ Reports being “blank” or “nothing” BODY

☐ Quality in body tone is held or lifeless

☐ Restricted body motions

☐ Crying, collapsed body (chest, belly)

☐ Overall muscle tension (deep internal muscles and tendons, holding tension)

☐ When asked to report experience, can’t sense or feel own body

☐ Reports body numbness

☐ Feels overwhelmed or too confused to sense the body

☐ Speech listless, repetitive with a flat tone MIND

☐ Memory loss, substantial time gaps

☐ Confused mind (time sequence off—in extreme fugue states)

☐ Attention impairment, delayed responses

☐ Delayed, slow responses in dialogue

☐ Avoids painful memories


Mindfulness orients the client internally to the ebb and flow of present-moment experiences. The non-judgmental nature of observing is critical to understanding your internal experience and growing your emotional capacity to feel and sense without becoming reactive or overwhelmed.


(INSERT JUDGEMENT ABOUT FREEZE STUFF OR IN ABILITY TO FIGHT BACK OR FEELINGS OF NOT BEING ABLE TO FEEL SAFE OR TO LEAVE, LEVINE TRAUMA.)


Mindfulness, and in particular embodied mindfulness, provides a resourcing and stabilizing aspect to the therapeutic process. Every time the client slows down and pays attention to the body in the present moment, the brain and body are being trained towards observation. This observation process inhibits emotional activation and is achieved by the prefrontal cortex down-regulating any overwhelm, confusion, or emotional triggers.


(INSERT BODY BRAIN INFORMATION HERE or Descartes error)


There are times when working with mindfulness is not appropriate or can activate the client further. As with any intervention or technique, the clinician needs to track and assess its usefulness for the client.


• Can’t stay in mindfulness: Can’t observe present experience, but jumps into thinking.

• Gets overwhelmed and flooded by internal cues; too much inner stimulation.

• Uncomfortable sensing and feeling the body. Not able to see this discomfort as a way to explore their experience but rather wants to push it away.

• Mindfulness and slowing down acts as a trigger. Going inside provokes traumatic memories the client can’t handle.


(INSERT TRE TO CALM FIRST)


Mindfulness/imagery/sensation/hypnotherapy:

You can guide the client through imagery or you can explore mindfulness through body sensation.


Imagery:

Use words/phrases such as:

• “See yourself walking slowly and mindfully…”

• “Look around and take in the peaceful environment…”

• “Imagine yourself fully in this favorite setting…”

• “Take in the beauty and calm right now…”


Body sensations:

Use words/phrases such as:

• “Allow your body to feel…”

• “Stay with the sensations of pleasure, calm…”

• “Slow down and feel into the body right now…”

• “Notice how you can breathe calmly in this moment…”

• “Sense into your body…”


Self-Regulation

An important skill in any of the somatic exercises is to witness oneself. The idea is to notice what is happening in the moment and in your body. You can witness your feelings, thoughts, sensations, movements and behavioral responses to people and situations. This skill is to learn how to self-regulate.


Steps to practice:

1. Suspend: Hit the pause button on anything that you are doing right now.

2. Notice: What is happening in your experience right in this moment.

3. Track: How you are feeling your body right now.

4. Stay: Don’t change anything, but stay present.

5. Continue what you were doing and see if you experience yourself differently.


Helpful questions to ask yourself:

• Where is my attention right now?

• How do I experience my body right now?

• What do I notice in my awareness right now?


EXERCISES TO CULTIVATE THESE SKILLS

1-15


The Neurocortex of body:

We have different “bodies.” This includes our skeletal, muscular, and fascia body, as well as our emotional, thinking and spiritual body. The way we move, hold our postures, use our muscles and faces can reflect our emotional and thinking life. There is a connection between how we feel and think and how we are; this presents in our bodies.


(INSERT PAIN SCIENCE FROM EXPLAIN PAIN RUBBER HAND PHANTOM LIMB)


(INSERT THE HIDDEN PSYCHOLOGY OF PAIN)


(Insert IMAGE OF CHART)

This chart helps you to identify these beliefs and how they show up in the body.


• Start with the physical body and note what you are sensing in the body. You can write on the body graph or circle the areas you feel and sense.

• Now focus on the emotional beliefs that stem from the physical experience of the body, such as: “My tense shoulders feel like I am carrying rocks and burdens for my family.”

• Move to the thinking body. This is what you believe about the physical and emotional experience. For example, “I carry these rocks because I feel responsible for what happened to my family. It’s my fault.”

• Pick two to three core beliefs that are most familiar and govern your daily experience. Reflect on these beliefs and look for how your body and your mind are interconnected.



Perception

Presence, perception and sensations are critical tools to understanding the non-verbal realm of your somatic experiences. How we perceive often determines what we believe and what actions we take.


(Insert the story of the rhino)


Getting to know the “how” of perception is important to truly grasping deep emotional beliefs and patterns. The more you can open-up and be curious about how your perception works, the more you become present to your direct experience of your body without a filter of inner dialogue or past stories.


(Insert the dialogue and tenets of NLP)


Sensations are the raw data.

(INSERT P-DTR and Mechanorecptor Theory)


There is a truth that emerges when you become present with your body, your sensate experience, and it opens you then to a wider sense of perceiving yourself and the world around you. The self-judgment begins to fade away and you are left with sensing what truly is.


(Insert the idea of culture buzzing around in the back ground from Ishmael)


(Insert the concepts from self mastery from Don Miguel Ruiz)


Finger Spreading induction into hypnosis

• Become mindful with your eyes open.

• Look around the room and notice the space in-between objects: Between chair legs, the wall space between paintings, the space between ceiling and floor. See how many spaces in-between objects you can make out just by looking around.

• Now focus on the space in-between your fingers. Look at your hand and notice that there is space between each finger. Start with a closed hand or fingers closed and then gently open the fingers. Start with the thumb and the first finger and so forth. Focus in on the opening and spaciousness between the fingers.

• Close your eyes. Can you still “feel” that space in-between? How is that changing your inner sense of your hand?

• Next, notice the space between thoughts, inner pictures and mental images. Allow the space to be there and rest in the space in-between.

(Edit THE HMI FINGER SPREADING TECHNIQUE)


MOVEMENT

When clients hear the suggestion of doing a movement exploration or exercise, some might freeze and assume they are supposed to dance through the room. Especially when there have been experiences of body shame, stunted expressions or physical trauma, the suggested “movement” instruction can be a challenge.


For that reason, it is a good practice to explain that the body is always moving. The body moves functionally through space every minute. The body IS movement, through heartbeat, peristaltic gut motion, synovial fluids in the joints—even breath moves the body. The body moves all the time, even when we are sitting still.


The intent is to offer tools that allow the client to feel and experience the benefit of movement without being triggered into shame or negative experiences.


(INSERT DON MIGUEL RUIZ GOAL BASED ANTI-SHAME love, law of attraction more of what you are plus admiration, patience, appreciation,)


Emotional patterns in the body—fear, anxiety and depression—restrict the full-functioning movement of the body. A moment of terror freezes the body into stillness and limits any range of motion due to fear of being in danger. When the frozen qualities of movement take over in the body, the motions the body performs become limited to basic functions and do not permit much expression.


(TRE IS A GREAT TOOL TO GET BACK TO NEUTRAL)


We can learn to minimize movement, and with that we are limiting feeling well—a life enriched and basic well-being. To be able to move fluidly, with free expression, is to become embodied. When we suggest movement to the client, we want to gently remind them that they are always moving and that they can achieve increased range of motion and well-being by doing the exercises.


Here a few tips when working with movement:

1. Don’t go beyond the comfort level of the client. At the same time, gently invite them to explore and discover. Open-inquiry questions such as “How does this movement want to unfold?” can be helpful.

2. Small movements have a big impact; it is not about how big or expressive the movement is, but how mindful and engaged the client is with their moving body.

3. Mindfulness and awareness are essential in moving; always encourage that.

4. Encourage exploration—what feels right and pleasurable in the movement.

5. Move with your client by mirroring when they move so they don’t feel like a fish in a bowl. (To learn more about mirroring, see Tool #54: Mirror, Mirror in this chapter.)

6. Psycho-educate your client that movement is natural and it’s not necessarily dancing.

7. Connect movement expirations with meaning. Ask the client what they are experiencing and what their meaning is.

8. Start small and build confidence over time.

9. Track for activation level. If the client gets too overwhelmed or can’t be with their experience, stop and re-evaluate.

10. Encourage play!


(INSERT BOOK ABOUT PLAY)


(INSERT BIBLE QOUTES ABOUT CHILDREN, LEARNING, NEUROPLASTICITY, SLEEPING, ADULTS LEARNING GYMNASTICS, FREESTYLE RULES)



BOUNDARIES

Setting boundaries is an essential skill. Before we can set boundaries, we need to “feel and sense” our boundaries. Those who grow up in families with poor boundaries or have had their boundaries invaded often experience traumatic boundary breaches. Boundary work is an essential aspect of healing one’s sense of personal safety and space.

Boundaries help define your personal space. Boundaries can be physical, emotional, verbal, behavioral and spiritual. They can also be strong, rigid, loose, open, flexible, distant, close, merged, or fluid. There are internal boundaries and also external boundaries between you and other people. This exercise will help you reflect on your boundaries.


Inquiry questions:

• How would you describe your personal boundaries?

• How can you tell where your personal space begins and ends?

• What do you feel in your body when someone comes too close to your personal space?

• What do you feel in your body when someone is too far from your personal space?

• Draw your personal space. Make a circle around the figure to indicate your personal space.


(Insert image of drawing)

• What color would your boundary be? __________________

• What material would your boundary be made of? ___________________

• Who is in your personal space and who is not?


Examples:

Friends

Close Friends

Acquaintances

Family

New People

Extended Family

Partner


(Insert IMAGE)


• What kind of boundaries did your family have? Were they strong, rigid, loose, open, flexible, distant, close, merged, fluid, etc.?

• Who in the family had the rigid boundaries and who had the loose boundaries?

• Think of a time when you did not feel comfortable and someone was too close to you. Imagine drawing a boundary around you as you envision this scenario. What words or actions can you take to re-establish this boundary?


(Insert BRENE BROWN’s WORK on Boundaries)

(Insert hypno script on boundaries using worksheet)


(INSERT TOOL 65- from Somatic book)


Posture

Posture reflects the inner climate of a person. We carry unconscious beliefs about our bodies as well as messages we have received on how our body looks.


(Insert image of the Whinne the Poo Characters)

(Insert the story about the blind mans victory)

(Insert the story about power postures/ Smiling/ Botox)


A lack of “feeling good in the body” can result in chronic body posture patterns that lock the person in an internal body state.

What internalized messages does the client carry about their body posture, its movement and function?


(HMI EXERCISES PARIS WINDOW AND THE BODY MESSAGE ONE)


Chronic fear shapes the body from the inside-out. Reflexes and strong feelings that are not resolved bring mechanical changes to the body structure. Muscle tensions that are ignored begin to shape the client’s inner experience and reactivity. Posture can be the first gateway into the sense of how the body’s feelings, emotions and muscular responses are in a dynamic interplay and interconnected. Kinesthetic sensations are connected with the central nervous system through bones, joints and fluids, and together inform the proprioceptive sensibilities and perceptions.


(TRE PSOAS as it relates to STRESS, POSTURE, PAIN, FLEXION, EXTENSION)


(INSERT THE TRUNK STABILITY ASSESSMENT and the perception of pain as well as the expression of strength is granted by the CNS, weakness is a protective mechanism)


Emotions and Self-Regulation

Part of a healthy body-mind connection is understanding our body’s signals and needs. When we develop as young children, our needs are met and regulated by adults. We learn to internalize how to care for ourselves by the way we have been cared for.


The caring touch, the empathic embrace, or the comforting voice of a kind parent helps us learn to self-regulate when we have strong emotions or are stressed. When the body learns that stressed moments or dysregulated body states such as thirst and hunger are not met, or are met with aggression, fear or threat, these regulating functions do not get appropriately internalized.


(INSERT ATTACHMENT THEORY AND RELATIONSHIPS)


The result is irritability and misunderstood or confusing body symptoms, that can result in anxiety or depression. Learning to recognize the need for self-regulation and re-learning the responses towards distress and stress are critical in health and well-being.


(INSERT THE BODY KEEPS THE SCORE)


Healthy self-regulation is knowing one’s body, learning to read one’s body signals, and knowing what to do when the stressors get high. The more we learn how to enhance our self-regulating capacity, the more resourcefully and creatively we can deal with life challenges. When we can improve our self-regulation, we also improve learning how to cope and be with a range of emotions.


Regulation is a learned process, one we integrate into our own lives by observing others and, importantly, through the attachment phases with our early caregivers. For example, an infant may hear a loud noise or become spooked by the sudden movement of a pet that wants to play. The infant perceives these small disruptions as potential threats to his survival. Unable to “fight back” (or do anything to stop the pet), the infant cries out for a caregiver to intervene and rescue him from the situation.

If the parent is attuned to the infant, she will pick up the baby, provide a physical embrace, and use soothing language to help calm the child’s neurological fight-or-flight response.

These interactions between parent and child will shape the child’s ability—or inability—to regulate his own emotions later in life. This process is called co-regulation because the parent steps in as a mentor and external source of soothing when the child feels distressed.- Nurturing Resilience

Functioning self-regulation is dependent on a strong thinking capacity, the ability to be aware and be reflective of one’s actions, thoughts and behaviors. This top-down strength of the prefrontal cortex can be enhanced by cultivating a strong somatic sense of self. The more the client can embody their experience and regulate their physical body, the stronger the mental capacity.


(INSERT POLYVAGAL THEORY IN THERAPY)


As described in the following tools, learning how to be in tune with the body can enhance self-regulating capacities. The happier the body is, the more spacious the mind and the more thoughtful the emotional decisions and behaviors we undertake.


Meaning Making: High-Road vs. Low-Road

How do you create meaning based on your experiences?


Do you rely primarily on the reasoning mind (the high-road), or do you depend mostly on the information you receive from your body-based emotional experiences?


The low-road is referred to when we instinctively respond to a situation. This is often in a traumatic or stressful situation when we engage the fight or flight response. But the low-road can also be an instinctive response that is well tuned to a situation or experience.


Do you use a combination of both the high and low roads to bring meaning and process your experiences and life?


Often these meaning-making modes are not recognized, but rather instinctual or based on a “feeling,” a “sense,” or a “gut feeling.” Becoming aware of how we create meanings is crucial to understanding our direct somatic experience. We want to notice when a fear overrides the reasoning brain and learn the mindful and somatic techniques to integrate, regulate, and calm.


We want to understand that the prefrontal cortex can help us out when we are emotional, and use thinking strategies to get through confusion or decision-making. Understanding where our basic physiology intersects with our body is part of understanding our whole human experience. Decisions are based on the meaning you attach to them. Reflect on the various ways you can make decisions and attach meaning to those decisions. What do you value most? How does your body or your mind respond? Do they respond in tandem? What is that process for you?


Think of a time when you made a calm and reasonable decision. How did you do this? What did that feel like?___________________________________________

Think of a time when you made an “emotional decision.” What did that feel like? In hindsight it was a good decision or a poor one?___________________________________ Think of a time when you made a body-based and instinctual decision.

What did that feel like?

How do you evaluate that decision in hindsight?_______________________________

What do you consider as a good decision and what meaning do you attach to it? ______________________________________________________________


(Insert thinking fast and slow)


(Insert NLP LEVELS of Identity)


(Insert the sleight of mouth principles)


(Insert dependency models based upon Erick Erickson’s developmental model, Being Patentified as a child, It didn’t start with you)


(Insert tool 79)


(Insert Perfectionist, Mistakes by dent, Radical Candor, Huffington Burnout.)


In The Moment Upset:

This exercise is a short practice to work with irritation, impatience or emotional agitation in the moment. It is designed to help the client work with their impulse-control issues. If a client has a tendency to quickly jump into a conversation or an action, have them practice this tool. The outcome is a calmer and more rational manner of engaging without being reactive. Practice this with your client in the office first to help establish a good habit. After a few practices, the client will be able to do this for themselves. Convey the importance of repetition. This is a powerful yet simple self-regulation tool the client can add to their daily living.


(INSERT EFT)

( A JOKE ABOUT BREATHING and counting to 10. Like it is that easy if I could do that than I wouldn’t be here learning from you, breathing is the next section.)



Breath Awareness and Techniques

Working with breath is a powerful somatic tool. You always want to track the breath quality. Open your awareness to include the breath quality of your client and reflect on how they are breathing when they are talking, exploring a theme, or experiencing emotions. This will give you insight and ideas on how to help your clients.


THE TRUTH ABOUT DEEP BREATHING

Often the first intervention a non-somatic therapist will suggest when noticing anxiety or panic trying to intervene into a client’s body, is to have them “take deep breaths.” Deep breathing is a wonderful and regulating activity; done correctly it can be very helpful for the client.

You might wonder which breathing tool is right for your client. Which tool should you start with? As with any somatic intervention tool, you need to use your common sense in conjunction with the data that you are tracking from the client’s body cues. If you notice the client is breathing quickly, a tool that brings forth calm and regulation, will be useful.

If you perceive that the client is more anxious, Tool # 93: Deflating the Tire of Anxiety will be beneficial. If the client needs an introduction to breathing awareness, Tool #91: Three-Part Breathing Sequence and Tool #88: Round-Wave Breath are good starting breathing techniques.

These tools do not need be used in progression. You want to familiarize yourself with the tools so you can have them at your fingertips when needed. You can skip around and use the tools as you see fit for your client’s needs. As with any somatic tools, you want the feedback from your client to guide you in what works and what doesn’t. Learning from your client is key in this process.


(INSERT Breathing types of PRACTICES, Wim Hoff, 4x4, Parana Yama, Kundulini, 7-1, PRI Practices, 20breaths protocol, Mackenzie method,cellular breathing tool 92)


Working with Sound and Voice


Think of the human voice, the pitch, the tone and making sounds as the storyteller of your body. In the nuanced tone of a human voice we can detect joy, sadness, anger and more. We don’t need to see. We can hear and sense the affective subtleties in the how we speak and sound.


The voice has a tremendous healing capacity. Low pitches seem to relax the nervous system of the body; high pitches excite it. Playing with sound into the body is a tool to stay present and inquire into the body.


Studies have shown that even after a short time of singing or sounding, the level of immunoglobulin A (antibody) increases and creates a sense of well-being felt in the overall mood of the person. You can use sounding to work with your inner states, but also to discover who you are in a sound-story.


Sounding into the Body

The body is made up of 70%-80% fluids. Since sounds travel in fluids, we can use this body system to create resonating sounds for well-being. While any sounds can be used, accessible and pleasant sounds, such as forming vowel sounds, are the easiest to do.


This practice of sound healing is an ancient practice that is done in many cultures. The benefit of sounding is to release anxiety and diffuse tension. Focusing on sounding can help elevate mood and alleviate negative thought patterns.


Sounding into the body is very helpful if a client can’t do movements or feels restricted in some way. The gentle breath and vibrations of sounds carry subtle movements to the body without the client “moving” in an active way.

INSTRUCTIONS

• Place your hands gently on the area of your body you want to “send” your sound into. For training purposes, it is easiest to place your hand on your chest and make an “O” sound. You can feel the vibration in the chest.

• Make the sound soft and repeat it. Take in the softness of the sound and vibration. What do you notice?

• Next, try an “A” or “Ahh” sound into the chest. How is that sound different? Is the effect of that sound creating a different experience than the “O” sound?

• Repeat each sound three to four times, then return to your natural breath and notice your body mindfully.

• Don’t push or exhaust your sound. As in any somatic practice, you want to be gentle and mindful of how your body receives the input. Follow what feels pleasurable and easy. The body will respond to this gentle sounding in its own way. The key is to be present to your experience.

• Once you feel comfortable with the sound, you can venture out and explore other sounds that come to you. It’s important not to force the sounds. Take pleasure in the sounding experience.

• Repeat as needed.


(INSERT PORGES SOUND SAFETY INFORMATION, INSERT, POLYVAGAL STIMULATION IN PRACTICE)


Time for a bigger cup:


Caring for yourself and others is not an either or problem. If you do not care for yourself than no one else will. It is not one persons job to make you feel ok other than yourself, your agency matters. Most Traumatized people have learned through implication that their needs, thoughts, bodies, beliefs do not matter. Often they rally against this notion and demand attention through their hard won accomplishments only to realize they do not provide a lasting change to their needs but an opportunity to continue to punish themselves. Or they have acquired a learned sense of helplessness and hopelessness. Navigating these needs through sustainable self-regulation techniques is the more direct intervention for Anxiousness or depressive symptoms, with the least amount of negative externalities.


The way we perceive trauma and the beliefs we form due to the trauma are both factors in resolving the symptoms. A common perception is that “time will heal,” but the beliefs that get created are often not taken into account in the process. The images below will aid in psycho-educating your client on their perception of their trauma and will provide a starting inquiry into what beliefs your client holds. A common belief is that as time passes, the trauma will shrink. What is more truthful is that the more resource the person develops over time, the more capable they become to deal with their trauma. Their “container” becomes bigger and therefore absorbs the trauma experience better. The experiences that resources provide become larger and will re-calibrate the original stress and trauma experiences. Thus, the importance of building resources in aiding the healing process.


SOMATIC RESOURCES THRIVING RESOURCES


A somatic resource is anything that creates a sense of calm and psycho-physical stability in the internal state of the trauma client—from a helpful memory to an internalized body awareness. A somatic resource becomes a refuge from the ongoing stimulus that life brings through the eyes of the trauma client. This gives one not just a means for survival, but a pathway towards a more fruitful and thriving life.


Survival Resources

• Survival resources are the flight-fight-flee responses of our bodies. They are effective for survival because they help us to cope under stressful and traumatic circumstances. When we can’t take anymore stimulation, we turn to survival resources. However, these are not useful if used repeatedly. Survival resources are beyond cognition; they are the body’s answer to severe stress and overwhelm.


Somatic and Thriving Resources

• Somatic and thriving resources help us to live to our full potential. They are the capacity to think, feel, sense and relate without activation or overwhelm. Somatic resources help rebuild and restore us to thriving and balanced lives. These resources allow us to stay with intensity and grow further, learn, and adapt without the damage to our bodies and nervous systems. Some of the key somatic and thriving resources that have been examined include:

1. Grounding exercises: Actively moving and connecting feet and legs to the ground beneath in a psychosomatic way.

2. Earth connection: A physical sense of belonging to the earth. This can be done by standing and feeling your feet on the ground, walking with awareness of the ground beneath you, or connecting with the idea that you are held up by the earth.

3. Walking with awareness in the body. This can be a simple walk in the neighborhood.

4. Working actively with the psoas muscle (the big fight or flight muscle): Use release techniques for easing the tension of the psoas.

5. Compassionate self-touch. Explore what kind of touch feels good to you. Experiment with gentle patting self-touch.

6. Therapist touch, when appropriate, safe and non-sexual. Touch needs to be provided with great care and attention to boundaries. Please consult your regional laws and ethics on this subject, or refer to a qualified body worker.

7. Sensory awareness: Simple noticing of the body as a practice. For example, you can sit in the sunshine and sense the rays on your skin.

8. Movement of body-expression, such as gentle movements and dance. Find out what movements feel right to you. Large dance movements or small intrinsic ones?

9. Working with pain: Renegotiating the sensory intensity through micro-movements and breath.

10. Breath exercises that enhance well-being. Increase your capacity for breath intake and exhale. Be playful and experiment with breath practices that feel good to you.

11. Mindfulness practices that engage the physical body.

12. Creative expressions such as art and writing, making or listening to music.

13. Nature: You can take walks in nature or use your imagination to visualize nature. 14. Physical exercise: Any exercise that creates a sense of well-being. Find out what helps you. 15. Visualizing in your mind a safe space to be.


Shame and Trauma

Feelings of shame can arise when working with the body in general. Deep-seated beliefs about the body can surface and the client might experience feelings that are “dark and shameful.” From a somatic therapy perspective, these are important moments not to be missed. You can gently acknowledge and normalize this in your client with empathic statements.

Shame feelings want to hide again and the tendency is to want to hide along with the client as these moments are truly difficult to witness. The very fact that you can accept these vulnerable moments is healing.

Shame feelings often surface particularly when trauma is associated. There can be a range of emotions connected along with it such as:

• A strong urge to hide and withdraw emotionally

• Negative self-criticism, bordering on abusive self-talk

• Feeling humiliated, ashamed

• The urge to be secretive and avoidant


Shame never feels good and most of us want to get away from it or hide the experience as quickly as possible. Shame can bring forth a tendency to want to be secretive and hide the true self. As therapists, we are also somatically inclined to want to help cover up that moment of shame and collude in looking away or not mentioning what is happening.

We know instinctively that we don’t want to say something to make it worse, and yet not saying anything is also a bad option. When working somatically, you want to encourage kindness and a gentle, mindful exploration of the shame feelings. At the same time, you want to give room for the client to retreat and move on.

In the beginning, exploring shame can be after the fact, meaning that once the shame attack passes, you can invite the client to reflect and be mindful of the past experience. The more you talk about it and work with it, the less power the shame will have. You are normalizing this body feeling like any other feeling in the body.

Gentle inquiry questions such as, “That was powerful. Is there anything that makes you curious about what just happened?” can be enough to have the client gain some control and interest in the experience. Once the client has embraced this, you have an opportunity to work with the shame attack when it happens.

The truth is that the actual shame attack lasts only seconds; however, the internal experience and the meaning it holds can last a lifetime. The less power these lifelong messages have, the less frequently the shame attacks occur.

Often past shame experiences are coupled with having been “outed” by someone. The classic example of turning red and then being called out for being red-faced hints at the dark power of being outed.

The body responds to being an outcast as a life threat. Being cast out from our human tribe is a hardwired primal fear and can mean life or death. The body registers this and responds with the flight, fight, freeze system.


VERBAL CUES

If the client uses the following words to describe their experience, pay attention to any corresponding body cues that may indicate shame is present: “Ridiculous, foolish, stupid, dumb, humiliated, helpless, inept, dependent, small, inferior, embarrassed, worthless, weak, idiotic.”


BREATHING CUES

When a client talks about the shame experience or has a shame attack, pay close attention to breath quality. You will see breath patterns similar to when the client has a trauma activation. Breath is one of the easiest body cues to track for the presence of shame. Look for cues such as: Flat and held breath, constriction in the throat, difficulty breathing, small and measured breaths as if sipping the breath in, complaints of chest constriction, tight lips and short bursts of breath in or out, or rapid breath high in the chest.