When Bessel van der Kolk published The Body Keeps the Score in 2014, it introduced millions of people to something trauma clinicians had observed for decades: that trauma is not only a psychological event. It lives in the body — in patterns of tension, activation, shutdown, and physiological response that persist long after the threatening event has passed.
Understanding this changes how we think about trauma treatment.
The nervous system's role in trauma
Trauma activates the body's threat-response system — the fight, flight, or freeze response mediated by the sympathetic and parasympathetic branches of the autonomic nervous system. Under normal circumstances, these responses complete their cycle: the threat is addressed (or escaped), the survival response discharges, and the nervous system returns to baseline.
With overwhelming trauma, this completion doesn't happen. The energy mobilized for survival has nowhere to go — particularly in situations of freeze or immobility, where neither fighting nor fleeing was possible. What remains is a nervous system that is stuck in partial activation: chronically slightly too alert, slightly too tense, slightly too reactive, reading neutral situations as potentially threatening.
This is not metaphor. It is the physiology of unresolved trauma, and it has measurable neurobiological correlates.
How somatic approaches engage this directly
Traditional talk therapy engages trauma primarily through the mind — through verbal processing, cognitive restructuring, and narrative. Somatic approaches work directly with the body's experience as part of the therapeutic process.
Somatic Experiencing (SE)
Developed by trauma researcher and therapist Peter Levine, Somatic Experiencing is grounded in the observation that animals in the wild routinely experience threatening events and — because they allow the natural discharge of the survival response through movement and shaking — don't develop chronic PTSD. SE therapy works with the incomplete discharge of traumatic activation by:
- Developing interoceptive awareness: the ability to track sensation in the body
- Working with the "felt sense" of trauma — the diffuse, physical impression of an experience
- Making small, titrated contact with traumatic activation and tracking what the body wants to do
- Completing interrupted survival responses through gentle, supported movement
- Building a larger "window of tolerance" — the range of activation the nervous system can experience without moving into overwhelm or shutdown
Sensorimotor Psychotherapy
Sensorimotor Psychotherapy integrates somatic work with attachment theory and trauma processing principles. It works with the body's automatic postural responses, defensive movements, and orienting responses as primary access points to traumatic material, alongside verbal and emotional processing.
Body-centered elements in EMDR
While EMDR is primarily a processing protocol, it inherently incorporates somatic awareness — the bilateral stimulation engages the body, and EMDR therapists track somatic responses throughout the process. Many EMDR therapists integrate somatic techniques for clients who need additional support with regulation and grounding during processing.
When somatic approaches are most valuable
Somatic approaches are particularly indicated when:
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Verbal processing is destabilizing. For some trauma survivors, talking about the trauma repeatedly increases activation without reducing it. Body-based work offers a different access point that avoids direct verbal engagement with traumatic content.
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The trauma is pre-verbal. Early childhood trauma, developmental trauma, and trauma that occurred before verbal memory consolidation is stored in the body and procedural memory rather than in narrative form. It may not be accessible through talk-based approaches at all.
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Dissociation is present. Body-based grounding and orientation techniques can help clients stay present during processing rather than dissociating when distress escalates.
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Somatic symptoms are prominent. When trauma expresses primarily as chronic pain, tension, fatigue, dysautonomia, or other physical symptoms, working directly with the body makes clinical sense.
Integration with other trauma treatments
Most trauma specialists at MMHC use somatic principles as part of a broader integrated approach rather than as a standalone modality. EMDR and CPT provide the evidence-based processing framework; somatic techniques enhance regulation, grounding, and nervous system awareness.
MMHC's trauma-specialized therapists work with adults dealing with all types of trauma. A first appointment clarifies your history and the approach most suited to your specific needs.
Learn about EMDR and other evidence-based trauma treatments →