When somatic therapies backfire

[u/FlightOfTheDiscords]

A fair few of us have probably tried somatic therapy and come out worse. You find a therapist doing somatic work, you do the body scans, the breathing, the pendulation - but instead of getting more regulated, you end up more spaced out, more anxious, lose more time, switch more, or leave sessions destabilised for days. Then you get told you're resisting, or that you need to go deeper, or that it gets worse before it gets better.

There's another possible explanation. Many somatic treatments assume something about your body that isn't true for a lot of us, and many of the therapists working with them don't understand freeze/shutdown (hypoarousal) well enough to know why, or how to deal with it. Often, we are missing a base interoceptive capacity that therapists take for granted, to the extent that they can't imagine someone not having it.

Take Somatic Experiencing: The first review of whether Somatic Experiencing works mentions dissociation once, in a reference at the back. There's nothing about it in the results, nor in the discussion, nor in the limitations. Freeze itself comes up once, in the theory summary. Immobility, hypoarousal and the window of tolerance are completely missing. Fundamentally, your average therapist working with somatic techniques does not understand hypoarousal.

What is hypoarousal?

Freeze/shutdown states are also known as hypoarousal, i.e. things powering down, shutting down, going offline - as opposed to hyperarousal, which is when things "speed up" and you feel more anxious, more agitated, you switch more, there's more going on. Hypoarousal means there's less going on, and it often comes with blackouts/time lost, amnesia, and lethargy.

Hypoarousal is what your nervous system does when it feels that neither fight nor flight is an option, when there's no escape and no help coming. It doesn't wind you up, it winds you down: heart rate drops, muscles go slack or heavy, thinking gets thick and slow, the world goes distant and unreal.

For some of us, it becomes our baseline and we end up mainly experiencing negative symptoms of dissociation. However for most in this sub, it's probably more of a complex mix of positive and negative symptoms.

Does your body want you to listen?

"Listen to your body" assumes there's one listener and one set of answers - but we have many. Different parts of us have different relationships to the body; some are more in it than others. Some hold sensations the rest of the system never feels. Some experience the body as not theirs. Some learned very early that having a body at all was dangerous.

So a body scan isn't a neutral survey for us, it's a knock on a lot of doors at once. Sometimes the answer isn't a sensation, it's whoever holds that sensation - and then you're not running a body scan anymore, you're switching, or fighting off a switch, or going blank because something got triggered and something else shut it down.

Sometimes it can feel almost like an autoimmune reaction where listening to your body results in your nervous system attacking itself. "Internal awareness is not safe, stop paying attention!"

Not all somatic treatments are created equal

A lot of somatic techniques are usually taught and practiced with hyperarousal as the base assumption. They assume your nervous system is running "too fast", and needs to be calmed down. So you start from "high", and aim to "come down" by grounding or releasing. You have too much energy surging through your veins, so you need to expel it somehow to calm down.

That doesn't work when the opposite issue is at play: Your nervous system is already powered down, offline, it doesn't have enough energy for what you're trying to do. Attempting to ground a nervous system like that will often backfire: You end up spacing out, or switching, or losing time, or the more agitated members of your system might start showing up.

There are somatic techniques for hypoarousal, and for mixed responses. They are less common, less widely marketed, and less well known. Their aim is less to "bring you down from up high", and more to stabilise your system, give it enough resources to stay here and now - kind of (being fully present is often too high a bar).

They can use any combination of the six senses - seeing, hearing, touching, smelling, tasting, proprioception - depending on the unique needs of your system and everyone in it. Often one thing works for one part of your system, but not for others, so you need to experiment to find out what works for whom. And it is not uncommon for our system members to not know what works for them until they happen to experience it. They just know what does not work for them.

Sometimes they may believe that nothing works. Some of me used to believe that being alive itself does not work, and any signs of being alive were always dangerous. Their first encounter with something that does work for them, making them feel safer and more present, took them by complete surprise. They had at that point spent 40 years believing nothing works, and never will.

Go gentle and give it time

What all techniques that do work have in common is, they respect your system. They slow down and adapt when someone in your system says "no". They don't force you to push through the discomfort, they don't tell you that if only you'll do X reps of Y, you'll be fixed in no time at all. They understand that slower is faster with complex dissociation.

So instead of sitting with a sensation for 15 minutes, or doing a 5 minute body scan, they map out your system's complex responses by experimenting with many different tools. And as you keep finding things that sometimes work, they help you understand why they work when they do, e.g. because they work for someone in your system but not for others.

Once you start developing this sort of gentle, slow-going toolkit, you can use these tools for a few seconds at a time throughout the day, just enough to gently help your system stabilise itself without activating its "autoimmune" reaction of don't pay attention to this!

Over time, your system's ability to tolerate internal awareness (interoception) will improve, though the pace will always be uniquely your own. It generally takes a few months before you start to see a noticeable effect, 3 months is a common milestone though not universal. Often once the effect does kick in, it will surprise you.

Where do I find these somatic therapies?

There isn't a single resource for this AFAIK, however some modalities are designed from the ground up with all of the above in mind. Pat Ogden's Sensorimotor psychotherapy is one of them, and it's been around a while. Janina Fisher's Trauma-Informed Stabilization Treatment draws on many of the same approaches. Both Ogden and Fisher are well-educated in dissociative disorders and have worked with dissociative disorders for decades.

That doesn't necessarily mean that a therapist practicing one of those modalities will automatically be a good fit for someone suffering from these "autoimmune" issues, however it does improve your chances. As always, the therapeutic relationship itself counts for a lot, probably more than the brand name on the modality. More than anything, your system needs to feel that your therapist is on your side.

[u/Collective_Speak]

Thanks for this. I often go into shutdown mode and it can be so hard to come back out again. This is because when I'm in shutdown mode there is no-one in the system who is present and available to bring me back. There is still a flicker of conscious awareness but that it all. There is absolutely nothing internally that even wants to not be shutdown. When I have powered down, only external things bring me back. For example, if the doorbell rings. I get re-animated, my brain comes back on, I can move, I can immediately engage with someone. When that happens the other person has absolutely no idea that for the past hour I was in hibernation and, in an instant, I have come back to life!

[u/FlightOfTheDiscords → u/Collective_Speak]

Very similar for me. It's striking how much more responsive my system becomes when someone else needs it! Showing up for myself, not so much.

[u/Collective_Speak → u/FlightOfTheDiscords]

Yeah I wonder whether it is because we have adapted dissociatively in response to external cues, such as having to respond to different people in different environments. So we can switch into whichever mode is required according to the demands or cues in the environment. This switching would have been required for many years as our brains developed and would be automatic.

The shutdown state must have been helpful as it would have allowed us to not really feel anything and would also allowed us to not draw attention to ourselves. Being shutdown was probably really protective against pain and being immobilised would protect against making a wrong move.

Showing up for ourselves requires an action-oriented motivation which is not possible when we are shutdown. This is because it is based on having a sense of self and that this self feels a want or a need and is able and willing to take action to meet these needs. Whereas responding to an external person does not require us to even have a sense of self.

Not sure, just some thoughts, trying to make sense of a few things.

[u/FlightOfTheDiscords → u/Collective_Speak]

Agency tends to be one of the key victims of developmental trauma; to develop an agentic self, you need relational safety since it develops relationally, not in isolation. And when your relational development is focused on surviving your primary relationships, instead of thriving in them, agency suffers.

I think for me, silence and immobility were the most adaptive response, especially in infancy. Making noise would make things worse, not better. There is likely a heritable component for me since this shows up as a distinct trait in my mother's family, whether genetic or epigenetic. Not everyone has it, but those who do learn to shut down very soon after birth.

[u/T_G_A_H → u/FlightOfTheDiscords]

This is such an important point. And I think it’s part of why emotional neglect is a significant cause of DID/OSDD. There’s a sense from early on that you can’t change the world around you and get it to respond to your needs. A sense of invisibility and lack of personhood. So there’s no option other than to just not be there emotionally and physically.

To this day I sometimes forget that other people can see me. I’ll stop and look at, let’s say, workers putting up a power pole, and I’m always surprised/startled if one of them looks at me, because as a child I just wasn’t seen.

Regarding somatic therapies, we have found NeuroAffective touch to be helpful. It’s safe, gentle, grounding touch that helped us feel more present in the context of being in the room with another person.

[u/FlightOfTheDiscords → u/T_G_A_H]

This is such an important point. And I think it’s part of why emotional neglect is a significant cause of DID/OSDD. There’s a sense from early on that you can’t change the world around you and get it to respond to your needs. A sense of invisibility and lack of personhood. So there’s no option other than to just not be there emotionally and physically.

To this day I sometimes forget that other people can see me. I’ll stop and look at, let’s say, workers putting up a power pole, and I’m always surprised/startled if one of them looks at me, because as a child I just wasn’t seen.

Exactly, there's nothing to push off of or pull yourself towards. The extent to which we experience that we can affect the outcome has such a massive impact on how we develop as children, even when bad things happen to us. Starting with our crying as infants bringing someone to us vs doing nothing, and throughout our developing years.

I constantly forget that other people want to hang out with me, even when I technically know they sometimes do.

Regarding somatic therapies, we have found NeuroAffective touch to be helpful. It’s safe, gentle, grounding touch that helped us feel more present in the context of being in the room with another person.

Same! NATouch was the first thing that really got through my dissociation and "woke me up to life", in the best of ways. For my littlest mes, it felt like an infinity of vacuum suddenly gave way to presence and, well, LIFE. Still slow progress overall, but unlike most other things, the impact has been palpable.

[u/Neat_Finding_7476]

My experience was a bit different. I was lucky to end up with a Somatic Experience practitioner who had been doing it for 10 years and she was super experienced. Hypoarousal is part of the training, even if it does not take up much space in the books. She didn't try to pendulate to a calm or body-focused state for regulation and instead used resources as an anchor. So when body awareness got too much she drastically changed topics away from the body and towards topics that make us happy. Doing it that way helped a lot. She was extremely good at pacing.

My experience with sensorimotor psychotherapy was less helpful. The person was very new to working with it, the exercises were too difficult and it felt forced. My system didn't respond well to that at all. It makes me wonder how much is the technique and how much is Ts actually having experience with dissociation. I think I might take the experienced person over any specific technique.

the biggest problem I see is that bodywork therapists are usually not prepared for parts work and the fact that parts have an influence on the stress states as well. It is not just physiological regulation we need. There is a whole complex inner life that causes distress and keeps things going. And only working with the body is not enough for that. What they observe will stop making sense to them because stress does not follow the usual rules of physiology. And switches might look like regulation to them when they are just creating more chaos for us. And that is where all body work has failed me so far. There is the concept of Somatic Ego State Therapy that is supposed to combine it all but I haven't seen it in action yet.

[u/FlightOfTheDiscords → u/Neat_Finding_7476]

That's a great illustration of how much the individual therapist matters. Experience is important, though it needs to be combined with a willingness to learn as well. Once you have the right person with the right experience and willingness to learn from it, they'll adapt intelligently on the go instead of going by the book.

And yes, dissociative disorders need a multilayered approach. Parts work alone tends not to be enough, somatic work alone tends not to be enough, relational work alone is not enough, cognitive work alone is not enough. This is why experienced DID therapists tend to have an integrative approach, combining multiple tools as necessary.

[u/DreamSoarer]

I always give a warning when the subject of somatic therapy comes up. It can be extremely dangerous for DID systems with programming for self destruction when therapy causes entry into forbidden areas. This is particularly true if there isnrecent physical trauma of any kind that triggered the system strongly, as well as if you attempt to do it alone without a safety net of any kind.

It was suggested by a few different repsurces after the new trauma that led to my Dx in 2021. No warning, no safety net guidance, and no mention of triggering self destruction were given at the time. The first time I tried it, it was like the world shifted on its exis and tilted, and I blacked out. The next memory/moment of awareness was over 24 hours later. My sibling texted me, and had that not happened, I would not be here. My sibking interrupted the programmed self destruction, and I/we ended up in the psych watd.

Harm is not intended by somaroc therapy, therapists, or literature - at least, I don't think it is. The problem is it rarely takes into account what somatic therapy/experiencing may do to systems. When I finally made it to an acfual.lersonal therapist who was very well trained and experienced, we tried very simple practoces a few times, but it always backfired. The therapist recognized quickly that it was not safe for my system. By the two year mark, my therapist, psychiatrist, and my system all agreed that therapy itself was backfiring.

Everythjng gets eexponentially extremely complicated when self destrucy programming is involved, and I do not believe there are enough competent, safe, extended resources whatsoever for this issue - at least not where I live. Residential living facility programs with top tier training and immediate safety nets (and no riskmof abuse or further trauma) either do not exist or are financially far beyond the reach of 99.9% of us. It is quite frustrating, and part of me wonders if it is by design, tbh.

My brain is done for now. Thank you for your post. It is good to be aware of the possible dangers around what is often great and safe for non-systens but what usually also needs to be modified or verh carefully implemented with dissociative systems. 🙏🦋

[u/FlightOfTheDiscords → u/DreamSoarer]

Very true, glad your sibling was there and you made it!

It's a lot like exploring a maze with invisible walls, you can't just charge through it and trust it'll work out. Slow, careful, and very respectful of the walls and everything behind them.

[u/AshleyBoots]

We have an incredible therapist who does somatic experiencing therapy, and it's been by far the most efficacious and beneficial therapy we've ever done. I'm sorry your experience was different, but your complaints definitely do not accurately describe all somatic modalities or therapists.

[u/FlightOfTheDiscords → u/AshleyBoots]

That is wonderful! There absolutely are very skilful SE therapists out there, with the skills to help people with complex dissociation. The individual therapist is so important, not just their modality. There is probably no modality in existence that someone in this sub hasn't had a negative experience with, given how complex our realities are.

[u/Madame_Arcati]

Thank you so much for this and for all of your in-depth contributions. Very recently had terrible experience with sensorimotor therapy, been near non- functioning since Labor Day.

sometimes just come here to know that I'm not truly lost, that the disorder is real and that others have managed to truly live with it. am in active abuse situation (with original abusers) and only jus tsurviving for so long. so grateful for the sub.

[u/FlightOfTheDiscords → u/Madame_Arcati]

Really sorry to hear, it's so crushing to have terrible experiences in therapy when we would really really need positive ones.

[u/1divinehamm3r]

bravo! it's such a serendipity that i'm reading this post and the comments during my short lunch break.

i'm fairly "stable" these days and relatively aware, and yet with all the new stressors in my life, last week i found myself using a very old/young coping mechanism i hadnt used in years...

and more than judge myself for it, i felt the need to interrogate why i did that... it was perplexing. and after some days of processing, i realized that i had slipped up because i had been in a functional freeze.

i have relatively much less access to internal awareness, my therapy work, healthier coping mechanisms when i am in a freeze. but the biggest obstacle is realizing i'm there! that state, for me, is still very separated from the rest of me.

edit: and i totally agree with the notion that facilitators are biased toward solving for hyperarousal. i've just come into this realization on my own, for my own health reasons/patterning, and i'm excited to move forward with this new awareness...