Integrating Mind and Body

Somatic Therapy offers Holistic Approach for Patients and Practitioners

By Sue Coyle

Talk therapy in some form is the modality most think about when they consider seeking counseling or even becoming a counselor. Cognitive behavioral therapy (CBT), for example, has long been the most utilized and researched form of psychotherapy in the United States and globally. In fact, it has been described as the gold standard, with millions of individuals seeking out CBT each year.

However, CBT and other forms of talk therapy may not work or may not fully meet the needs of every individual in search of healing. “I don’t want to knock talk therapy. A lot of people are making a whole lot of progress in talk therapy,” says Marian Thompson, LCSW, SEP, a psychotherapist in private practice in Austin, Texas. “[But] at some point, they may think, ‘Is there something more that might get to this? I understand my trauma and I have my coping strategies, but I can still feel it in my body.’”

For those looking for something additional or different from talk therapy, there are other modalities. One such subset of psychotherapy is mind-body therapy, a holistic approach that incorporates, as the name implies, both the mental and the physical.

Mind-Body Therapies

Mind-body therapy, also called somatic therapy, is an overarching term that refers to a number of different therapeutic modalities. It is described as a bottom-up approach to therapy, as it begins with a focus on the physical body. This is different from the more prominent talk therapies.

“For decades, cognitive approaches like CBT have been the dominant framework for mental health treatment. These therapies focus on changing thought patterns to influence emotions and behaviors, helping individuals challenge negative beliefs and develop healthier ways of thinking,” explains Katrina Clark, LCSW, a holistic psychotherapist in Hawaii. “While this approach can be helpful, it often falls short of addressing the root causes of suffering, particularly when trauma, chronic stress and nervous system dysregulation are involved. The reality is that our emotions, memories and past experiences are not just stored in our thoughts; they are embedded in the body and the nervous system.”

Kelly Caul, MSW, LCSW, SEP, founder and lead psychotherapist at Empowered Therapy LLC and founding director of Empowered Spaces in St. Louis, Mo., agrees. “We [mind-body therapists] are taking a body-based perspective. We’re also including the narrative and the beliefs. It’s this wraparound holistic approach about how has our body been impacted? How is trauma living in the nervous system?”

When an individual experiences a trauma or a threat of trauma, the body goes into survival mode. The response is commonly described as “fight or flight,” and more recently, “fight, flight or freeze.”

“When we aren’t able to complete that fight or flight, the survival response gets thwarted. It gets held in the body. [In therapy], we meet the body where it’s at and create enough safeness in the conditions to help the individual complete the survival response. We look at how do we create this container for this individual so what needed to happen but wasn’t able to, can happen in safeness,” Caul says.

Mind-body therapy can take many forms and encompass a variety of techniques. For example, Karen Schwartz, LMSW, TCTSY-F, C-IAYT, yoga therapist and trauma sensitive yoga facilitator at Mindful Living in New York City and the director of operations at the Massachusetts-based Center for Trauma and Embodiment, offers both yoga therapy and trauma sensitive yoga sessions.

Yoga therapy is a form of mind-body therapy that uses yogic exercises as well as the breathwork and meditation in yoga to help an individual address their trauma. “Yoga therapy is more prescriptive,” Schwartz explains. “There is an element of ‘Here are my issues, here are my symptoms, and here are some things to work with.’ Someone comes in with a presenting problem, and we do a holistic assessment to determine different interventions to offer.”

“A trauma sensitive yoga session is ‘I’m going to practice with you, whether in the room or online. I’m going to offer you a practice with choices. You’re free to do them in the ways that I’m offering or find your own way or opt out.’ I may suggest to you that you might notice something in your body,” Schwartz says, but the approach is very client-centered. “They are in charge. They have the choice of how they want to interact on a moment-to-moment basis.”

Other types of mind-body therapy include or may incorporate similarly well-known mindfulness practices, such as meditation, acupuncture and massage, or in the case of Julia Gladstone, LSW, MFA, a psychotherapist and facilitator in Philadelphia, deep listening.

“Deep listening is a created and mindful practice that was developed by the experimental composer Pauline Oliveros. While the original focus of the work is on expanding skillfulness around listening to a wider spectrum of sounds, my specific research focus was about studying and experimenting with attention,” Gladstone says. “I see therapeutic work as an art of repatterning, and attention is this elemental component that frames whether we see things as we have been habituated into seeing them or whether we can grow towards a wider spectrum and notice the details that were previously obscured.”

Another increasingly popular form of mind-body therapy is Somatic Experiencing. This is not to be confused with somatic therapy. As alluded to above, somatic and mind-body are often used in place of each other when describing the group of therapies within this umbrella. Somatic Experiencing therapy is a type of somatic therapy.

“Somatic therapy and mind-body therapy are kind of the same thing—anything that integrates body and mind. Somatic Experiencing is a trauma modality where you are looking for possibly the fight or flight energy that has not been released, that is trapped in your body because of some sort of trauma or chronic stress,” describes Thompson. “You are looking for ways to discharge that energy.”

Thompson further explains that Somatic Experiencing therapy “goes a lot slower than talk therapy, because in order to be able to track what is going on in your body, you have to go a little slower.” Within the therapy there is pendulation—going back and forth from challenging material to a place of safety—and titration, which focuses on moving gradually and gently through the process.

The slower pace may seem frustrating to some, but, says Caul, “Sometimes, slower is better. People pretty quickly get behind that idea. They see how they feel so much differently. It’s not taking them into overwhelm. It’s how can we resource the system even just a little bit more? Is there a way to soften or bring a little bit of relief?”

Benefits and Challenges

The benefits of incorporating the physical aspects of trauma and healing with the more traditional components of therapy are many, according to proponents of these modalities, and, as expected, extend to both physical and mental well-being. Memorial Sloan Kettering Cancer Center, which offers mind-body workshops and therapies to individuals receiving cancer care, notes that “A growing body of research indicates that mind-body therapies are safe and effective ways of mitigating physical and emotional symptoms, and improving coping skills in cancer patients. Because these practices are pleasant, noninvasive and beneficial, they are most suited for patients and survivors to help manage their own care.”

Thompson adds that, specifically, Somatic Experiencing therapy allows an individual to become more curious and look more closely at what is already being felt in the body and what is leading to those feelings. “If you’re noticing what’s going on in your body, there are things that are tied to that. Memories can come up of other times that you felt this way.”

Of course, the benefits are not guaranteed, and like talk therapy, mind-body therapy or a specific type of mind-body therapy will not work for everyone. Some may find great success with yoga therapy, for example, while others prefer a modality such as Somatic Experiencing or a talk or other experiential therapy.

For a mind-body therapy to have a chance at progress, the individual entering into therapy must be open to the finer points of the modality. “Most people that find me are already interested in this,” says Thompson, adding that she does recommend that prospective clients are in a place of relative stability. “People who are deep in addiction or have a severe mental illness that they are just sort of discovering [may want to wait on Somatic Experiencing therapy]. This can really open things up. It can open up trauma, and some people may not be ready for that.”

Even for those who have done some research and purposefully sought out a mind-body therapist, the actual therapy itself can require a new level of openness. “Our western culture has historically placed a premium on rationality, individualism and intellectual thought. The mind, with its logical thinking and cognitive functions, has been viewed as the seat of control and agency,” says Clark. “In this context, therapies that focus on the mind are comfortable and acceptable to both the clients and the therapists because they align with cultural values of reasoning and understanding. Addressing emotions and physical sensations requires a level of vulnerability and self-awareness that many people are not accustomed to. Also, the use of language in traditional therapies allows individuals to feel as though they have more control over their healing process.”

Expanding Utilization

As understanding of mind-body therapies and their benefits continues to grow, so too does its availability and accessibility. In the United States, there are many private practitioners who offer a form of mind-body therapy. There also are organizations that have incorporated somatic therapies into their services.

Memorial Sloan Kettering Cancer Center offers mind-body workshops and therapies to patients and survivors. It is not alone in doing so. Additional hospitals and health systems, including Mount Sinai in New York and Jefferson Health in Philadelphia, also offer mind-body programming.

Similarly, the Department of Veterans Affairs has partnered with the Veterans Yoga Project (VYP) to offer yoga and mindfulness trainings at veteran medical centers. Dr. Dan Libby started the VYP in 2010, and it became a nonprofit in 2011. It offers yoga classes, as well as trainings in Mindful Resilience, which Brianna Renner, CEO of VYP, explains is a training designed for yoga teachers and mental health clinicians, but open to all. Renner sees the power of yoga in helping veterans work through challenging and impactful traumatic experiences.

“Yoga often makes us feel,” she says. “Sometimes, those thoughts and emotions can be scary. With these tools and practices, we are striving to create a space that is safe, predictable and accessible, in a controlled environment. We can recognize the traumatic event from a place of non-attachment and just observe. I’m crying on my yoga mat, and it just needs to happen, so it’s happening.”

“Stepping off the mat a little bit is a sense of community,” Renner continues. “The transition [out of the military] is a hard one, and it’s really easy to kind of forget who you are. The government does a really great job of telling you how to be a service member but not a civilian.” The Veterans Yoga Project, she says, helps create the community and camaraderie that is often missed post-discharge.

Building Awareness with Social Work

The growth of mind-body therapies offers additional opportunities for social workers to serve individuals. Many of those currently providing mind-body therapy are licensed clinical social workers. However, for more social workers to consider providing this type of treatment or incorporating it into their practice, they need to be exposed to it. For that to happen, two things need to change, or at least continue progressing. First, social work students, particularly those on clinical tracks, should have the opportunity to learn about different modalities of clinical treatment, including mind-body therapies. When Thompson was in school, she says she “did not feel like I was introduced to a lot of different modalities, not at all to the somatic therapies.”

Gladstone, the Philadelphia psychotherapist and facilitator, says the training she draws from most has come outside the frame of her MSW. “In my MSW program, I was exposed to CBT, psychodynamic therapy, solution-focused therapy, and motivational interviewing. All of these modalities are talk-based rather than somatic in orientation. I have appreciated my exposure to them, but none have become central to my work.”

There is hope this is changing. Some schools of social work do offer courses on mind-body therapies. However, most of the classes are offered as continuing education courses, not as a part of the general curriculum. In fact, the University of Denver is one of the only schools of social work to list a mind-body course in its curriculum, offering “Mind-Body Connections in Social Work Practice.”

Nonetheless, the courses offered are a start, and as understanding of trauma continues to grow, so too may the knowledge and the availability of that knowledge around different types of trauma treatment. After all, nearly all of those interviewed stated that their discovery of somatic therapy coincided with their learning more about trauma.

“There is more of a traction right now around trauma-informed care, so that gets me excited and hopeful,”says Caul.

Additionally, more research needs to be done on the impact of different types of mind-body therapies. With more evidence about what does and does not benefit the individual, practitioners and professions can move forward with greater confidence as therapists and teachers of therapists. That may be difficult, as both Caul and Schwartz point out that other therapies are considered more easily measured, but research on somatic therapies can and will expand and with it, the therapies’ availability and accessibility.

Mind-body therapies may never earn the designation of gold standard that CBT holds, but they are a viable option for many looking for a different type of help.

Sue Coyle, MSW, is a freelance writer and social worker in the Philadelphia suburbs.