Somatic Experiencing (SE)

Theory of change

Change occurs when traumatically fixed defensive arousal can be processed in small doses, recover movement and come to an end within a present experience of safety and agency.

Core ideas

1. Trauma is defined by a survival organisation that persists

   Somatic Experiencing shifts the focus from the objective severity of the event towards the organism's response when the threat overwhelms its possibilities for action. The traumatic reaction retains arousal, constriction, immobility, collapse or dissociation and can be reactivated long afterwards as if the danger were still present. Treatment is directed at that lived organisation, not only at the chronology of the event. (Levine, P. A., & Frederick, A., 1997, Waking the Tiger: Healing Trauma; Levine, P. A., 2010, In an Unspoken Voice: How the Body Releases Trauma and Restores Goodness).

2. Renegotiating differs from reliving

   Levine uses renegotiation to describe a form of processing that approaches the components of the traumatic response without repeating the event at an intensity that would reproduce powerlessness or disorganisation. The experience is revisited from the present, in fragments and with the capacity to enter, leave, observe and complete protective actions, so therapy seeks to transform the way the organism responds rather than to intensify an abreaction. (Levine, P. A., 2010, In an Unspoken Voice: How the Body Releases Trauma and Restores Goodness; Levine, P. A., 2015, Trauma and Memory: Brain and Body in a Search for the Living Past).

3. Relative safety is a condition of processing

   The model places relative safety at the beginning of the work because the traumatised person needs to perceive refuge, support, options and enough predictability to explore their sensations without being left alone with them. The therapist's regulated presence lends containment, but the clinical aim is for regulation to become increasingly accessible from the patient's own resources. (Levine, P. A., 2010, In an Unspoken Voice: How the Body Releases Trauma and Restores Goodness).

4. The felt sense gives access to experience before it is turned into an account

   SE works with the direct perception of tension, temperature, breathing, pressure, vibration, posture, movement and impulse because many traumatic reactions remain organised implicitly and procedurally. Bodily attention is not used to control the body, but to recover an observing relationship with cues that were previously experienced as indecipherable or dangerous alarms. (Levine, P. A., & Frederick, A., 1997, Waking the Tiger: Healing Trauma; Levine, P. A., 2015, Trauma and Memory: Brain and Body in a Search for the Living Past).

5. SIBAM avoids reducing trauma to a single channel

   The SIBAM model organises experience through sensation, image, behaviour, affect and meaning and makes it possible to intervene wherever there is the greatest possibility of regulation. An image may be fixed while the sensation becomes tolerable; a behaviour may reveal a defensive impulse that the patient cannot yet name; a meaning may change when the body recovers mobility. Integration appears when these channels stop being fragmented or hijacked by the threat. (Levine, P. A., 2010, In an Unspoken Voice: How the Body Releases Trauma and Restores Goodness).

6. Pendulation and titration restore rhythm to a fixed system

   Pendulation makes it possible to experience the movement between contraction and expansion, arousal and settling, while titration turns the survival response into amounts small enough to be processed. Together they constitute the technical core that avoids both rigid avoidance and flooding, showing the organism that it can approach arousal and return to more stable states. (Levine, P. A., 2008, Healing Trauma: A Pioneering Program for Restoring the Wisdom of Your Body; Levine, P. A., 2010, In an Unspoken Voice: How the Body Releases Trauma and Restores Goodness).

7. Active defences restore agency and healthy aggression

   In SE, the recovery of actions such as orienting, moving away, escaping, pushing, protecting oneself or setting boundaries can bodily contradict the organisation of powerlessness. Levine distinguishes that protective aggression from violence: it is directed, proportionate energy that restores the capacity to act, and its integration can lessen the cycle between freezing, shame, self-attack and explosive rage. (Levine, P. A., 2008, Healing Trauma: A Pioneering Program for Restoring the Wisdom of Your Body; Levine, P. A., 2010, In an Unspoken Voice: How the Body Releases Trauma and Restores Goodness).

8. Immobility resolves when it is uncoupled from terror

   Immobility can be a temporary biological response, but in trauma it becomes bound to fear, helplessness and expectations of catastrophe. SE seeks to have the person contact that state in small doses and return repeatedly to regulation, allowing immobility to recover an autonomous exit instead of tipping into panic, disorganised flight or collapse. (Levine, P. A., 2008, Healing Trauma: A Pioneering Program for Restoring the Wisdom of Your Body; Levine, P. A., 2010, In an Unspoken Voice: How the Body Releases Trauma and Restores Goodness).

9. Discharge is a process of regulation, not a catharsis to be forced

   Tremors, changes in breathing, heat, relaxation and other spontaneous changes may accompany the exit from survival arousal, but SE does not pursue them as proof of healing. The clinical criterion is that the process maintains orientation, choice, pace and the capacity to settle, so that it contributes to a dynamic equilibrium instead of generating a new overload. (Levine, P. A., & Frederick, A., 1997, Waking the Tiger: Healing Trauma; Levine, P. A., 2010, In an Unspoken Voice: How the Body Releases Trauma and Restores Goodness).

10. Integrating memory does not amount to literally certifying a recollection

    Trauma and Memory emphasises that traumatic memories can appear as sensory impressions, automatisms, partial images and intense affects, and warns of the risk of confusing subjective vividness with forensic truth. SE can work with the current impact of that material and the bodily response it organises without using suggestion or turning therapy into a machine for recovering or confirming memories. (Levine, P. A., 2015, Trauma and Memory: Brain and Body in a Search for the Living Past).

Influences

• Ethology
• Neurophysiology of stress
• Somatic psychology
• Ida Rolf's bodywork
• Wilhelm Reich
• Akhter Ahsen
• Theory of trauma and procedural memory

Key references

• Levine, P. A., & Frederick, A. (1997). Waking the Tiger: Healing Trauma. North Atlantic Books.
• Levine, P. A. (2008). Healing Trauma: A Pioneering Program for Restoring the Wisdom of Your Body. Sounds True.
• Levine, P. A. (2010). In an Unspoken Voice: How the Body Releases Trauma and Restores Goodness. North Atlantic Books.
• Levine, P. A. (2015). Trauma and Memory: Brain and Body in a Search for the Living Past. North Atlantic Books.