Somatic Therapy vs. Talk Therapy
By Benjamin Kagedan PsyD, Director of Clinical Training
Perhaps you’ve heard about somatic therapy through a friend, colleague, or Google search, and are feeling curious about just what it is and what makes it different from traditional talk therapy. As a therapist who has trained and worked extensively on both sides of the divide, I’d love to share my sense of the important distinctions between the two. Both ways of practicing are valuable, and certainly have a good deal in common. Which style you choose will depend on the issues you’re seeking help with, your past experiences with therapy, and your personal sense of what works for YOU.
(Note: the kind of talk therapy I’m thinking of here is what clinicians call “psychodynamic” talk therapy, that more open-ended, exploratory, emotion- and relationship-focused version of therapy that you see often in the media. Cognitive-behavioral therapy is in a different camp, being a more pre-programmed and instructional approach to the work.)
Let’s start with what talk therapy and somatic therapy have in common: THE CLIENT LEADS THE WAY. For both talk-based and somatic therapies, it is you the client who will determine what gets talked about in a given session, and in the course of the therapy as a whole. The phenomenon underlying all exploratory therapies is that when we let the mind roam freely, it inevitably points us back and back and back again to the issues, feelings, and memories that are most important and most in need of attention.
What’s more, the openness of the session allows for everything and anything to come forward. Those feelings and memories that we spend the least time talking or thinking about in daily life, because of how painful or shameful they seem, are usually at the heart of our ongoing struggles in life and love. All therapists working in this tradition are trained to create safe and comfortable spaces for these repressed thoughts and experiences to come into the light. Only then does genuine self-understanding and self-acceptance become possible.
Case Study
So both kinds of therapy allow the client’s mind to guide the process toward what is most important. But what happens when we land there? That’s where the two approaches really start to diverge. Let me use an example based on my real work with clients to illustrate:
A client has spent the first 15 minutes of a session catching me up on the latest challenging episode in their dating life. They went on a first date that was feeling like a great connection, and part of the way through, expressed to their date how excited they were feeling about this connection. When they asked the person out for a second date, the answer was no. My client was understandably stung by the rejection, but also reported feeling quite angry, as if being punished simply for being kind and candid. I could hear the anger rising as their voice got faster, higher pitched, and more emphatic: “I try to show up just being authentic, sharing my genuine feelings, and they tell me that I did something wrong. And then I am supposed to feel guilty. It’s not fair!“
In my talk therapy days, I would have had a few options as to how to continue, all of which involve continuing the conversation in some way.
One option is to prompt my client to keep talking (“What happened next?” or “Go on…”).
Another would be to reflect back what I was hearing (“So her explanation really made you upset and angry…”), hoping that my verbal summary would help my client get some kind of extra clarity about the situation or at least stay with this subject longer.
A third option would be to try connect it to a larger pattern (“Has this kind of thing happened before?”), prompting the client to think and come up with a similar memory from their dating life, or just say no.
A fourth would be to help them try on another perspective (“What do you imagine might have made them say that to you?”).
Or if we had done enough exploration of early life before that moment, I might risk an interpretation (“This reminds of me of what you’ve said about trying and failing to get more affection from your mother, I wonder if your reaction could be connected to that?”). In the best case scenario, the client agrees heartily, seeing a genuine connection. More typically, they respond with passing interest or flat out rejection. And even the best case is often followed up with “Ok, so what do I do with that?”
And so on. Now, like I said, this approach was not without therapeutic value. By helping my clients keep their thoughts trained on a particular feeling or experience, the therapy session allowed them to learn and share more and more about themselves. They developed a more comprehensive understanding of how their early life affects their present outlook and behavior. And in the warmth and safety of our relationship, we were able to make space for thoughts and feelings that didn’t feel okay to have anywhere else.
But at a certain point, I started to feel like all I knew how to do was help people have more words and thoughts. They would tell me about emotions, and I would encourage them to just keep saying more and more words about those emotions. One way or another, every tool was some version of “Do you have any more words about that?” or “Here’s a thought I’m having about that feeling you had. Do you have any further thoughts you can share in response to my thought?” I sensed that the full transformative potential of therapy could not be realized just through an ongoing exchange of thoughts, no matter how compassionate and patient.
A new toolbox
Learning somatic psychotherapy offered me an extraordinary new option. Rather than forcing clients to turn their emotions into thoughts and words, I learned how to help clients turn toward their emotions AS EMOTIONS. Emotions certainly have thoughts and words attached to them, but those are arbitrary and malleable. At their root, emotions consist of particular sets of recurring sensations in our physical bodies. Once the therapy process stops being dependent on constant verbal back and forth, emotions are allowed to come into the conversation and speak for themselves.
The key is mindfulness. I don’t mean the kind of mindfulness you practice at home or with a group, maintaining focus on the breath or another stimulus. What I mean is the opportunity to slow down in the middle of a conversation, stop speaking, and just feel inwardly toward the emotion that is happening right now. When we are allowed to do this, we get a much richer and more direct experience of the emotion. Maintaining that quiet, internal focus on an emotion gives the brain time to light up the important unconscious associations and experiences connected with it, those that don’t often come to mind when we are just thinking and conversing.
Here’s an illustration of how I worked with that same situation using a somatic approach:
Client: “I try to show up just being authentic, sharing my genuine feelings, and they tell me that I did something wrong. And then I am supposed to feel guilty. It’s not fair.”
Therapist: “Seemed like there was some emotion that came up when you said “it’s not fair”. Would it be okay to slow down and bring some awareness toward your body, and then say those words again, and see what happens?”
C: “That sounds good.”
T: “Great, so take a few moments to let your awareness settle on your body in the present, and when you feel ready, just say the phrase out loud, a few times if you like.”
(a few moments pass quietly)
C: “It’s not fair!…It’s not fair!…I start to feel sad”
T: "What’s letting you know you’re feeling sad right now?”
C: "There’s a sinking feeling in my stomach, clenching in my throat”
T: "I see, and so would it be alright to keep hanging out with those sensations of sadness for now?”
C: “Yeah, it’s okay.”
T: “Great.”
(a few moments pass quietly)
T: “So really taking your time, notice if there’s any way this kind of sadness feels familiar, or if there are any memories arising with it.”
(another brief period of quiet)
C: “Yeah.. I suddenly have this memory of being little with my mom, when I would want to keep cuddling, but she would walk away because she had something else to do.”
Look what happens when we allow the client to turn inward during the session and study their emotion up close. We find out that their anger is not just anger, but a secondary reaction to an underlying grief. The client discovered it for themself, a direct experience that they can trust much more easily than my interpretation. Next, by staying patiently and quietly with the sensation of sadness, another direct experience occurs - a memory connects today’s events to childhood experiences of powerlessness and loss, the terror of abandonment. We get to understand the whole sequence of events - the speed with which my client reached out for emotional validation, and the intensity of the feeling after being rejected - in terms of the childhood dilemma of having no control over mom’s attention.
With this insight in place, my client becomes able to turn with care toward their hurt feelings, rather than be stuck in defensive anger. The client is able to see that their excitement about this new potential new love interest activated an attachment strategy rooted in early experiences of loss and abandonment. They are able to see the urgency with which they reach out for emotional validation as an old attachment strategy that is no longer serving them. Back in real life, they can start to be mindful of those kinds of impulses as they come up in future dating opportunities, pausing to tend to their attachment anxiety internally rather than reaching out prematurely. With more awareness comes more behavioral choice.
This was just a tiny snippet of what somatic therapy looks like in session, but illustrates what can change when we let the process get slower and quieter, when we let the client get right up close with their feelings, and when we stop relying just on words and ideas to get us where we want to go.