There’s a moment many of my clients describe — usually, it’s something they’ve known for a long time. Not consciously, not in words, but in the tightness in their chest before a difficult conversation, in the way their shoulders rise when a certain topic comes up, in the exhaustion that descends every Sunday evening without explanation. The body, it turns out, has been keeping records. And this isn’t a metaphor. It’s simply proven neuroscience.
The Body as an Archive
Long before we had language to name our experiences, we had nervous systems designed to respond to threat, connection, and safety. These responses — the racing heart, the frozen limbs, the shallow breath — are ancient survival mechanisms that operate well beneath conscious awareness. The problem is that these systems don’t always know when the danger has passed. They store what the mind tries to move on from.
Bessel van der Kolk, one of the most influential trauma researchers of the last thirty years, has described this phenomenon extensively: the body continues to respond to past experiences as though they are happening now. His work helped shift the field toward what clinicians call “bottom-up” approaches to therapy — interventions that begin with the body’s experience rather than with thoughts and narratives.
This is the foundation of somatic psychotherapy.
What “Bottom-Up” Actually Means
Traditional talk therapy — cognitive approaches in particular — works “top-down.” You identify a thought, examine its validity, and try to change it. This works well for many concerns. But for experiences stored in the body — such as trauma, chronic stress, and relationship patterns laid down in early attachment — cognitive reframing alone often isn’t enough. You can understand intellectually why you react the way you do and still find yourself reacting the same way.
Somatic therapy works differently. Rather than starting with thoughts and working down, bottom-up approaches focus on the body and what researchers call “body memory” — emphasizing the importance of subcortical brain levels, such as the brainstem and limbic system, and working upward toward higher cortical systems. In practice, this means paying attention to what is happening in the body right now: the sensation in the throat, the weight in the chest, the subtle urge to pull away or lean in.
These sensations are not noise. They are information.
What the Research Shows
Somatic approaches have historically been underleveraged in mainstream mental health — not because they don’t work, but because they were harder to study within traditional research frameworks’ limitations. Luckily, that has been changing in the last decade.
A 2024 meta-analysis published in BMJ Mental Health, examining 112 studies and over 9,000 participants, found that somatic therapy produced an effect size of 1.24 for PTSD — outperforming both traditional psychotherapy and pharmacotherapy. These are significant numbers in a field where treatment effects are often modest.
The first randomized controlled trial of Somatic Experiencing — one of the primary somatic modalities — found significant intervention effects for post-traumatic symptom severity with a Cohen’s d between 0.94 and 1.26, alongside meaningful reductions in depression. For context, an effect size above 0.8 is considered large in psychological research.
Across multiple studies, body-oriented procedures have been shown to be effective interventions not only for PTSD symptoms but for comorbid symptoms as well — including anxiety, depression, chronic pain, and the kind of emotional dysregulation that shows up in relationships as reactivity, withdrawal, or persistent disconnection.
What This Looks Like in a Session
People sometimes imagine somatic therapy involves unusual physical exercises or touch. In a virtual context — and in my practice generally — it looks much quieter than that.
It might sound like: “Where do you notice that in your body right now?” Or: “What happens in your chest when you say that?” Or simply slowing down, staying with a sensation for a moment longer than the mind wants to, before moving on to interpretation.
Somatic therapists support clients in tracking pleasant and unpleasant sensations within their window of tolerance — with those sensations as the primary entry point for intervention, before engaging the meaning or emotions that may be attached to them.
This sequencing matters. When we go to meaning too quickly, we often bypass the experience entirely. The body gets bypassed too — and continues to hold what wasn’t processed.
In working with couples and individuals navigating relationship challenges, I often find that the most important work happens not in the story of what happened, but in noticing what the body does while the story is being told: i.e., averted gaze, held breath, hands’ position, posture, or mind wandering away from the main topic, impulse to reach out or pull back. These are not incidental. They are the relationship, expressed somatically.
The Nervous System and Relationships
Polyvagal theory, developed by Dr. Stephen Porges, offers another lens for understanding why somatic work matters in relational therapy specifically. Our nervous systems are designed for co-regulation — we literally calm each other down, or activate each other, through proximity, tone of voice, facial expression, and breath. Long before we were capable of language, we were reading each other’s bodies for signs of safety or threat.
In relationships where safety has been repeatedly disrupted — through conflict, betrayal, emotional absence, or early attachment wounds — the nervous system learns to stay alert. Hypervigilance, reactivity, numbness — these aren’t personality flaws. They’re protective adaptations that made sense once and now cost more than they provide.
Somatic work in the context of relationship therapy helps clients recognize these patterns not as character deficits but as nervous system responses — and, with time, to develop new responses that are more functional and desirable rather than automatic.
An Honest Note
Somatic therapy is not a replacement for all other approaches, and it is not right for everyone at every stage. Finding an experienced somatic therapist can be challenging, and the research base, while growing substantially, is still developing compared to traditional mind-oriented approaches (such as CBT). Good integrative practice draws on multiple frameworks — and the relationship between therapist and client remains, across all modalities, one of the strongest predictors of outcome.
What somatic work offers is access to a layer of experience that traditional therapy alone often cannot reach, or would require many years to do so. For people who have tried to think their way out of patterns that won’t budge, or who feel disconnected from themselves in ways they can’t quite articulate, it can open something.
The body has been trying to tell you something. Somatic therapy, at its best, helps you finally understand it.
If you’re curious about whether somatic-informed therapy might be right for you, book a free 15-minute call — it’s a good place to start.
References
Brom, D., et al. (2017). Somatic Experiencing for Posttraumatic Stress Disorder: A Randomized Controlled Outcome Study. Journal of Traumatic Stress.
Kuhfuß, M., et al. (2021). Somatic experiencing – effectiveness and key factors of a body-oriented trauma therapy: a scoping literature review. European Journal of Psychotraumatology.
Schauer, M., et al. (2024). Psychotherapy, somatic therapy, and pharmacotherapy are all more effective than control in treatment of PTSD: A meta-analysis. BMJ Mental Health.
van der Kolk, B. (2014). The Body Keeps the Score. Viking.
Porges, S. W. (2011). The Polyvagal Theory. W. W. Norton & Company.
Levine, P. A. (1997). Waking the Tiger: Healing Trauma. North Atlantic Books.