Sensorimotor Psychotherapy stands at the intersection of neuroscience, psychology, and embodied healing.  Because trauma first and foremost affects the body, the body itself holds the key to healing from the debilitating effects of traumatic experiences.

This therapeutic approach places an emphasis on the body as a reservoir of information, a target for intervention, and a catalyst for transformative change.

This article will delve into the core principles and practices that define Sensorimotor Psychotherapy, examining its application in the treatment of the intricate interplay between the body and the ongoing legacy of traumatic experiences, including dysregulated arousal and instinctive defensive responses,

Bottom-Up and Top-Down Processing:

To understand the primary principles of Sensorimotor Psychotherapy, one must first grasp the triune brain metaphor, as proposed by Maclean in 1985. This conceptualization divides the human brain into three components: the reptilian brain, housing survival instincts (cry -for-help, fight, flight, freeze, shut down); the mammalian brain, the seat of subjective emotions; and the neocortex, responsible for declarative knowledge and thought.

This theoretical framework lays the groundwork for an approach  employed in Sensorimotor Psychotherapy that draws upon the physical, emotional, and cognitive patterns to heal from trauma’s legacy.

This therapeutic method incorporates both “top-down” and “bottom-up” interventions. While traditional psychotherapeutic approaches often rely on insight and cognitive meaning-making (neocortex), Sensorimotor Psychotherapy uniquely integrates bottom-up interventions.

These interventions target autonomic nervous system arousal and instinctive defensive movements rooted in the reptilian brain.  Resolving the effects of trauma involves addressing deeply ingrained neurobiological and procedural patterns of arousal and instinctive defense that may be impervious to traditional “top-down” resolution that is based on thinking and insight..

Regulating Arousal and Somatic Resources:

The threat of traumatic events can stimulate hyperarousal to fuel flight/flight and cry-for-help defenses, or hypoarousal to fuel shut down states.

When trauma is unresolved, physiological arousal can remain dysregulated even when the trauma is over, which can be debilitating for the survivor  A central tenet of Sensorimotor Psychotherapy is the regulation of arousal so that the survivor can experience a sense of calm and safety.

Remember that trauma first affects the body, thus the root of dysregulation lies in the physiology and movement  patterns of the body, which then in turn affect feeling and thinking patterns. Clients are guided to mindfully recognized the bodily signs of dysregulation, as well as associated thoughts and emotions, and to find physical actions that modulate arousal.

These physical actions, or “somatic resources,” such as aligning the spine, grounding through the legs, and regulated breathing, become tools for clients to mitigate dysregulated arousal.

The therapist assists clients in experimenting with a variety of somatic resources, fostering a sense of growing mastery over their neurobiological responses. Gradually, clients learn to draw upon the body as a resource to modulate the extremes of arousal that may have become deeply ingrained due to unresolved trauma.

Addressing Phobic Responses to the Body:

Clients with complex trauma often harbor phobic responses to their bodies. The body becomes a source of repulsion, terror, and is often perceived as having betrayed the survivor.

Negative attitudes can manifest as neglect of basic self-care, self-harm, extreme risk-taking, and a deep-seated hatred for the physical self. Sensorimotor Psychotherapy acknowledges and addresses these challenges by helping clients realize that this phobia is understandable after trauma, and gradually learn to befriend the body

The therapist assists clients in gradually shifting their perceptions of the body from one of fear and repulsion to a more accepting and regulated state.  This can be accomplished by normalizing the phobia, helping clients realize that they instinctively defended themselves as best they could at the time of the traumatic event, and slowly learn to appreciate the capacities of the body and to treat it with care.

Involuntary Movements and Defense Mechanisms:

A distinctive aspect of Sensorimotor Psychotherapy is its attention to involuntary preparatory movements, often referred to as “actions that wanted to happen.” These are instinctive impulses to defend and protect oneself that are rooted in the body.

Impulses, such as striking out, pushing away, or fleeing, represent the body’s readiness for defensive actions, but have often been abandoned because such actions were impossible at the time of the event, or would have made the trauma worse..

Therapists actively track and contact these preparatory movements during sessions. For instance, a subtle tension in the legs might signify a readiness to flee, while lifting the fingers could indicate a readiness to push away or fight.

By encouraging clients to mindfully follow these preparatory movements and execute the corresponding actions, therapists facilitate a sense of mastery over the body’s defensive responses.  Although defensive actions were typically not possible or effective at the time of the trauma itself, and often would have made the trauma worse, executing them in therapy can reinstate a somatic sense of being able to protect oneself in the here and now. .

The Therapeutic Relationship and Implicit Communication

Interventions in Sensorimotor Psychotherapy occur within the context of a resonant therapeutic relationship. This relationship is pivotal for strengthening the client’s ability to collaborate, engage, and find the courage to execute new actions that may have been deemed dangerous or futile in the past.

The attuned intersubjectivity in this therapy requires drawing on implicit body-to-body communications such as prosody, empathy, body language, facial expression, proximity, eye contact, and the balance between seriousness and playfulness.

Movement interventions are not mere physical exercises but emerge organically within the intersubjective relational context. The therapeutic alliance relies not only on explicit communication but on implicit non-verbal interactions to connect with clients, to up or down-regulate the client’s arousal as needed, and to provide the safety to successfully utilize somatic interventions.

This nuanced approach communicates beneath the words to maximize the therapeutic advantage by addressing that which cannot be articulated in words.

Dissociation and the Structural Dissociation Model:

Sensorimotor Psychotherapy draws on the structural dissociation theory, developed by van der Hart, Nijenhuis, and Steele. This model elucidates the aftermath of repeated trauma, where one part of the self remains fixated in instinctive defenses, while another part(s) associated with daily life functions attempts to return to and maintain normalcy.

The metaphorical concept of “parts of the self” signifies the lack of integration between daily life systems and defense mechanisms. Each part holds a distinct affective truth supported by its self-selected array of evidence.

Sensorimotor Psychotherapy pays meticulous attention to the manifestations of these parts in the procedural and regulatory tendencies of the body. Clients learn to recognize physical signs associated with different parts, and to use the body itself to help these parts communicate and integrate.

Phase-Oriented Treatment Approach:

Sensorimotor Psychotherapy adopts a phase-oriented treatment approach which encompasses three phases: regulation of arousal, behavior, and emotion (Phase One); reprocessing traumatic memory, completing or regulating instinctive defensive responses (Phase Two); and addressing relational effects of attachment and relational failures, proximity-seeking actions, and other movements that support overall success in life (Phase Three).

The therapist often shares this three-phase model with clients to communicate that a series of steps exists to gradually resolve the effects of the past. Importantly, clients understand that the first task of therapy is to stabilize dysregulated arousal, which can lead to maladaptive behavior.

These phases, though presented in a sequential manner, are fluid rather than rigid, allowing therapists to adapt the treatment to the evolving needs of each client.

In conclusion, Sensorimotor Psychotherapy emerges as a comprehensive and nuanced approach to trauma treatment. By integrating insights from neurobiology, dissociation theory, the dynamics of therapeutic relationships, theories of human connections and attachment, historical and sociocultural influences, as well as from somatic theory and practice, this modality offers a pathway to healing that encompasses both mind and body.

The intricate dance between top-down and bottom-up interventions, the regulation of arousal through somatic resources, and the focus on movements and body sensation make Sensorimotor Psychotherapy a unique and powerful approach in trauma therapy.

As our understanding of the mind-body connection continues to deepen, approaches like Sensorimotor Psychotherapy pave the way for a more holistic and integrated approach to mental health and well-being.

Dr. Pat Ogden is the Founder of the Sensorimotor Psychotherapy Institute