15 Oct When Talking Isn’t Enough: The Surprising Power of Somatic Psychotherapy
Editor’s note: This piece discusses mental health issues. If you have experienced suicidal thoughts or have lost someone to suicide and want to seek help, you can contact the Crisis Text Line by texting “START” to 741-741 or call the Suicide Prevention Lifeline at 800-273-8255.
When Mara described her panic, she didn’t start with a memory. She started with a body: “My chest tightens and I can’t get my breath,” she said. “Then the memory follows.”
That pattern — sensation first, story second — is exactly why traditional talk therapy sometimes stops short. Talking can change our view of a problem. When anxiety, shame, or trauma get trapped in the body, we need to address it. We can do this by focusing on sensations and finding ways to regulate our feelings.
The limits of words alone
Talk therapies (such as CBT) are said to be evidence-based for many problems. They help people reframe thoughts, test beliefs and build coping strategies. For some clients these approaches are sufficient.
The issue is that if the nervous system becomes dysregulated, cognitive change only provides a short-term solution. People can intellectually understand their patterns without changing them. They will still get “taken over” by bodily reactions — breath changes, tremor, numbness, tension. My clinical experience is that insight without regulation often gives short-lived relief.
What “body-oriented” counselling means
Body-oriented counselling include approaches like sensorimotor psychotherapy, Hakomi, Somatic Experiencing. They commonly emphasize noticing and working with bodily sensations, posture, breath and movement as a route to change.
The clinician helps the client notice their feelings. They track the changes they feel and work with the body’s defensive responses safely. The therapist will guide this through a verbal process, and help the client to also find meaning and insight verbally. The therapist may well suggest “homework” strategies such as practices to regulate the nervous system.
This is not anti-talking; it’s a “bottom-up” complement. Body awareness → regulation → then integration with meaning and narrative. Institutes like the Hakomi Institute describe the integration of mindfulness, body awareness and psychotherapy as central to practice.
What the evidence says
Systematic reviews and recent meta-analyses suggest promising but still limited evidence for body-oriented therapies overall. Reviews of body psychotherapy and movement-oriented interventions report positive outcomes in some trials (reduced symptoms, improved regulation). Specifically for Somatic Experiencing (Peter Levine’s method), reviews of the research find preliminary support for reduction in trauma symptoms and improved resilience.
Researchers need to conduct further work, but initial findings show promise. However, this is true of many forms of more in depth therapy. It is hard to get the funding to do long term qualitative research in these areas.
In short: the evidence points toward benefits, especially where emotional regulation and somatic symptoms are an issue. Researchers still need to do larger scale high-quality randomized trials.
There is however a strong theoretical basis for the somatic approach to trauma. Polyvagal theory and research into the fight/flight/freeze response demonstrate that trauma does reside in the body. We also know that the body will best release those responses on a physiological level.
The research literature into trauma references Peter Levine and Pat Ogden’s (sensorimotor psychotherapy) work extensively. Many people see somatic work as the cutting edge of trauma work.
Why the body approach can add something important
- Regulation first:
When the autonomic system is dysregulated, cognitive strategies can feel irrelevant. Body-based practice directly targets physiological arousal and interoception. Interoception is the body’s ability to recognise internal signals. These include physical feelings like thirst and hunger, as well as emotional signals.
- Completing defensive responses:
Somatic models focus on finishing unfinished fight, flight, or freeze responses. This helps the nervous system calm down naturally. It helps our body understand that the danger is over. We no longer need to react with fight, flight, or freeze.
- Accessing non-verbal memory:
Some trauma manifests in the body as feelings or movement patterns. These can be hard to express with words. Working with movement, posture and sensation gives access to that material.
These ideas match what we currently know about interoception, vagus nerve regulation, and embodied memory.
Practical, clinical examples (what this looks like in sessions):
- Anchoring attention to sensation.
The therapist invites attention to a felt sense (tightness, breath, temperature) and notices how it changes.
- Micro-regulation practices.
Techniques such as paced breathing (e.g. physiological sighs), noticing the environment, or gentle movement are used to change the state of the nervous system.
- Integration:
When arousal levels are lower, the therapist and client can discuss what happened in the session. This is where we gain insight and understanding.This helps us to make sense of our experiences. It also makes meaning out of what has happened. This helps to produce lasting change.
These interventions are brief and scalable. We can integrate them into conventional psychotherapy or deliver them as specialised somatic work.
Who is likely to benefit? Who might not?
Likely to benefit: clients with ongoing physical symptoms like sleep problems and chronic tension. This includes those with trauma histories, poor body awareness, and people who feel that just talking does not help.
– This is not suitable for people in a serious crisis who need medical help. Although it could be used as a support in a mental health setting.
– It is also not for clients who are not ready to pay attention to their body sensations. In these cases, we may need to do some groundwork. Careful clinical screening and trauma-informed practice are essential.
Conclusion
The case for body-oriented counselling isn’t about abandoning talk therapy—it’s about completing it. When we use bottom-up, body-centered methods, insights from conversation can turn into real experiences and meaningful changes. The body becomes an ally in integration, not just a physical vessel for carrying the mind, like a head on a stick.
For many clients, an integrated approach — regulation, movement, mindful attention and then meaning-making — yields more durable change. The Hakomi method is an example of a body of somatic, mindfulness based work that does this very well.
The research is still developing, but evidence shows that somatic approaches are vital for effective therapy. Especially if trauma plays a role, whether that involves developmental trauma or PTSD-type traumatic experiences.
These methods don’t replace talk therapy—they deepen it. For many clients, especially those with trauma or chronic stress, including the body in the process is important. It’s essential for genuine, lasting change.
Author bio
Ajay Hawkes is a psychotherapist in Fremantle who integrates somatic psychotherapy and mindfulness-based counselling with neuroscience-informed practice. He offers individual and group work that focuses on nervous system regulation and embodied recovery.
If you have experienced suicidal thoughts or have lost someone to suicide and want to seek help, you can contact the Crisis Text Line by texting “START” to 741-741 or call the Suicide Prevention Lifeline at 800-273-8255.
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Last Updated on October 15, 2025 by Marie Benz MD FAAD
