Ten Principles of Somatic Resiliency

The Ten Principles of Somatic Resiliency

These ten principles guide the way I try to be with my patients in any form of psychotherapy. I will list the first and then discuss each one in more detail.

1. Our first task when meeting a new patient is to find something to love and admire in them.
2. We always start with what is “right” with the patient rather what is “wrong” with them.
3. It must get better before it gets better.
4. We focus more on strengths and resources than on psychopathology.
5. Slower is faster
6. Less is more
7. Body sensations are easier for patients to recognize than feelings
8. The first homework assignment is the Resource Assignment. A copy is in the resource library under Handouts
9. Celebrate together all the small successes
10. Be creative, flexible, spontaneous, and don’t be afraid to be silly at times.

Now, let’s look at each of these in more detail.

1. Love and admire the patient

This comes straight from Ron Kurtz, the founder of the Hakomi Method, one of the first body centered psychotherapies. He said “My first inclination when I see a new patient is to find something in them to love, the heroic”. And I add ‘’to admire”. This one quote from Dr. Kurtz completely changed my entire practice a number of years ago. Love and admire. The way I look at it is “If I can’t fund something to love, appreciate, and admire in my patient, how can I expect them to find this in themselves”? Love is the foundation of the Somatic Resiliency approach. We keep looking all throughout the therapy process for what is good about them, communicating that to them, celebrating that goodness where we find it, and taking the time for them to notice and experience it in their body. This seems so simple but it is so healing. And we can do this no matter what nodality of therapy we may be using.

1. Start with what is right.

Starting with what us right is the approach taken after the initial assessment, after a basic understanding of the patient, and after an initial treatment plan has been made with the patient. We both have identified and know what the problems are. We both know what we will be working on. That is the essential ingredient which creates the beginning of a true therapeutic alliance. It is after we have chosen together where we are trying to go that the Somatic Resiliency approach really begins.

We have learned some things about the patient. We have already identified what we love, appreciate, and admire in the patient. We communicate this directly and get the patient’s agreement on the truth of these good things. Initially there may be some denial of the good as many of our patients have a low sense of self-worth. So, I then say something like, “I know it feels not true but can we take a step back and look objectively”? Most people are able to do this. This is the point where our journey really takes off.

We then talk about this good quality of themselves, where it came from, how it shows up in their life, and have them give an example to flesh this out a little bit. Now, I ask the question, “What do you notice about yourself when we talk about this”? or “What is it like for you to talk about this with me”? here is what I call a branch point. The answer will either be something like, “It feels good” or ‘I’m a bit calmer”. Or it could be “this makes me nervous” or “I’m really uncomfortable talking about something good in me”.

If we get one of the positive answers we ask them where they notice the calm or the good in their body or themselves. It is very important at this point that we not ask them about feelings. We ask about sensations. Feelings are often hard for our patients to access. Sensations are generally fairly easy. Then wherever they point to or say we invite them to notice that sensation for a minute or two. What we are doing is having the patient mindfully noticing themselves when the parasympathetic nervous system has been activated. That brief state is what Babette Rotschild refers to as an anchor. We will talk more about anchors and what we do with them but for now, this is what I mean by starting with what is “right” with them.

If we get one of the negative answers or anxiety answers (sympathetic nervous system state) that also is very useful. They have opened up an area of their relationship with us that we can explore, what the anxiety might be about or how they notice it. We then support and acknowledge them but we don’t stay there long. We gently guide them back what good we have identified. Invariably they then get over the shyness or fear of noting something good about themselves in the presence of another (us).

1. It must get better before it gets better

All of us who have been in therapy ourselves know how painful it can feel when discussing some private topics we previously have kept to ourselves. It hurts. It can also be a relief, but it can hurt. That is not what I am referring to here. Often our patients can feel bad for long periods after a session. When they tell us the next time they see us we often say something like, “It has to get worse before it gets better”. In one sense that is true. However, our patients have been feeling very bad for a long time before they come see us. I want them to feel something good, something positive in each session. It gives them hope and confidence right from the start that they will get better because they actually feel it in our offices. That positive is not a positive thought. It is when they mindfully note and experience the positive physical sensations of being in the parasympathetic state in the presence of another (us). Therapy is hard work for our patients. Much of the time they can be very anxious or dissociated. They need to experience and savor the parasympathetic states repeatedly, which gives them the continued hope and confidence they will be able to handle and work through the difficult part of the therapy.

1. Focus more on strengths and resources rather than psychopathology

Many of our patients have some sort of psychopathology (psychiatric illnesses). They include severe depression, eating disorders, substance use disorders, OCD, PTSD, and other anxiety disorders, some type of neurodivergence, schizophrenia, and bipolar disorder. Many may struggle with self-harm behavior and suicidal ideation. We have to address these disorders vigorously. I strongly recommend psychiatrists and psychiatric nurse practitioners maintain close coordination of care with others providing treatment for them. But even with the most severe disorders, we need to focus primarily the individual with strengths and resources which are still there even in psychotic states. best intervention for all patients with psychiatric illnesses is to spend more time in our sessions again on what is “right” with them. It creates a space for the therapeutic alliance to work in a collaborative way with their psychiatric treatments.

1. Slower is faster

We often are not aware of how fast we speak at times with our patients. We also tend to have trouble allowing enough time after a question and we ask our follow-up questions quickly. We tend to be too fast when doing guided meditations or any somatic modalities. Parasympathetic states need time to consolidate. Much more is accomplished when we slow down.

1. Less is more

When doing any somatic work we want to start from a relatively parasympathetic state. In the Somatic resiliency approach, we allow the patient to mindfully settle into that state before we go into the material or story or work that will activate the sympathetic system. As all of us who do somatic work know, the return back to a parasympathetic state signals the end of a cycle. Sometimes it is better to do only a few cycles rather than many in the same session. Spending more time in the parasympathetic state consolidates the work that was done. Less is more is a reminder to us to allow time for mindful integration of the work.

1. Body sensations are easier for our patients to recognize than feelings or emotions.

A lot of psychotherapy occurs in the zones of the limbic system and cortex, the realm of our thoughts, and emotions. We have all learned we must work a third area (the body) as well. Both Peter Levine of Somatic Experiencing and Pat Ogden of Sensorimotor Psychotherapy have both broken it down into five areas.

Dr. Levine talks about what he refers to as SIBAM. SIBAM stands for Sensation, Imaging, Behavior, Affect and Meaning. He relates these to what he describes as different channels to work in and help link together. Dr. Ogden refers to the same five areas in a hierarchical model she calls organization of experiences. The base is Sensation. Above that is Imaging. Above that is Motor Movement, then Emotion, then Cognition.

The organization of experience coincides when each of these systems come on line in our development. Sensation is basic. It is the primary way we experience ourselves in the womb. Upon birth there is an explosion of the use of sight, sound, touch, smell, and taste. By crawling and then walking movement becomes a prime way of experiencing the world. An infant expresses a variety of emotions as well, but there is a big jump around 18 months to two years when we start being able to say “No” to instructions and own our own feelings. Our cognition expands throughout development but the ability to abstract, make meaning, learn right from wrong behaviors internally, and cultural awareness really takes off as we get older.

I appreciate both Dr. Levine and Dr. Ogden as these two similar models give us a clear, simple way of always knowing where we are in a session. When I find myself sometimes at a loss for where we are going or need to go, I can easily regain my feet by seeing which of these modes we are working in and can help the patient link these different forms of experience together. I like Dr. Ogden’s model to help me understand that each level is dependent on those below. I like Dr. Levine’s model in doing work in the session as we are linking various channels such as movement and emotion, emotion and meaning, thoughts and images, or sensations and emotions etc. Dr. Ogden does a similar thing but calls it stitching together the organization of experiences.

Here are some examples of linking channels or stitching together organizations of experience.

I may be working with a patient developing resources and ask them about their dog. I will ask the patient if they can picture the dog in their mind (image). I then ask them what they notice in their body when they see the image of the dog (sensation). They may say a little warmness in the heart and I draw their attention to the movement they make as they place their hand on their heart area (movement). I the put my hand on my heart (relational component) and we both pay attention to that happy feeling (emotion) and may stay in that state for a brief time. We then talk about what they think about this experience and what it means to them (cognition)

Another example is when I notice the patient beginning to get anxious and ask about it (emotion). I can then ask what brings about the anxiety (image and cognition) or how they notice the anxiety in their body (sensation), or observe their leg shaking and bring it to attention (movement), comment on it and explain it is showing the impulse to run (movement and cognition) and then do an exercise where they simulate running by moving their feet in a rhythmic pattern, and ask them in their mind (image) to run to what they envision as a safe place (relational).

The total experience of integrating body sensation, imagery, body movement, affect, and mindfulness in a safe relational context, goes a long way towards healing the entire individual in a holistic way.

This type of mindful integration repeatedly is a major way to increase the resiliency of the patient.

1. The Resource Assignment

The Resource Assignment is the first written homework we use in the Somatic Resiliency approach. This homework can be very helpful no matter what type of therapy we are doing. Research has shown that a homework assignment to complete before the next session provide structure, improves confidence, solidifies skills, and increases the therapeutic alliance by linking the patient and their connection to you as the therapist throughout the week.

I like to start with the Resource Assignment as it helps me to understand what things already are associated with their resiliency. There are likely many questionnaires like this one. The one I use is adapted from David Kerr, SEP whom I used to work with. The questions are:

What are some of the things you are most proud of in your life?

Have pets been important to you?

What are some of the best places you ever visited?

What activity or activities make you feel most alive?

Has music been important to you?

Who in your life has most understood you?

Who in your life have you loved the most?

When you were growing up did your family do any fun things together?

1. Celebrate together all the small successes

This principle requires us as therapists to remain present, open, and sometimes to step out of our comfort zones. Celebration of a patient’s success can be small or large. The successes I am referring to are the times when the patient has taken a new step forward such as setting a needed boundary with someone in their life, or has come to a new understanding about themselves which makes them feel good. It could be when there has been a positive event in their life or when a relationship has been healed. The question to ask then is one that encourages mindfulness as well as allowing us to slow down to really take in the goodness. We don’t ask what was that like for you but what is that like (meaning here in the room with me). Then it becomes relational and you are able to celebrate it together in any way that seems best to you. One way that patients seem to like is I ask, “Do you want to celebrate this with me now”? I have never had a patient hesitate or say no. I then say, “Let’s put it in our bodies” and do the victorious arm pump movement while saying “Yes!” emphatically. I ask them if they want to do it with me, then if yes, we both do it together. Usually, we end up laughing or smiling. This joint experience of mutual shared joy is very healing. Each therapist can find their own best way to celebrate.

1. Be creative, flexible, and spontaneous

There are many ways to be creative and spontaneous. Some of the interventions are those we may use with a child but are just as helpful with adults. We can use drawing, sand trays, playing music that is very meaningful, even singing with them or at times dancing with them. When encouraging them to set a needed boundary we can stand up and act out with the whole body, practicing saying “No”. We can do power poses like Wonder Woman or Superman. I encourage us as therapists to do what seems natural and spontaneous, even if it is silly. These types of things can really enrich our talk therapies.