Somatic Experiencing

1. Introduction

Version followed: Peter A. Levine's Somatic Experiencing (SE) as set out in his nine "building blocks" for renegotiating trauma (In an Unspoken Voice, 2010), with session-level procedure taken from the composite case in Payne, Levine & Crane-Godreau (2015). Training is run by Somatic Experiencing International (formerly the Somatic Experiencing Trauma Institute, traumahealing.org). The SE Practitioner training is described as more than 200 contact hours, usually eight trainings over about three years. "Somatic Experiencing" has been a trademark since 1989. [source: Payne et al. 2015; Goodreads highlights of Levine 2010; Wikipedia; TPC video review 2015]

SE is a body-oriented, "bottom-up" approach to trauma and stress. It works mainly through the client's attention to interoception (inner sensation), proprioception (body position) and kinaesthesis (movement), not through detailed retelling of the event. Its theory of change: trauma is not a property of the event. It is a lasting dysregulation of the nervous system, in which survival activation (fight, flight, freeze or collapse) was never discharged or completed, so the system does not return to baseline. In Levine's words, trauma arises "when one's human immobility responses do not resolve". Change is said to come from approaching the stuck activation in small doses, from a base of safety and resources. The therapist then supports spontaneous discharge (trembling, warmth, deeper breath) and lets thwarted defensive movements finish, which brings back self-regulation, orienting and social engagement. The authors propose this "biological completion", rather than extinction, as the mechanism of lasting change. They present SE as a complement to cognitive and exposure therapies, not a replacement. [source: Payne et al. 2015; Levine 2010 via Goodreads highlights] SE explains itself through polyvagal theory (Porges), Gendlin's felt sense and ethology. These are the school's own explanatory frame, not settled physiology. [source: TPC review; Wikipedia] [synthesis]

2. Framework

SE has no fixed, session-numbered protocol. Levine gives nine building blocks. He says Step 1 must come first and Steps 1–3 follow in sequence. The remaining blocks are not a fixed order: they are drawn on as the session's process needs them. [source: Levine 2010 via Goodreads highlights] The phase grouping below is an inference from the building blocks and from Payne et al.'s case. It is not a staged model the sources state. [synthesis]

Working phase (inferred)	Levine building blocks	Goal	Move on when (criteria, [synthesis] unless cited)
A. Safety and stabilisation	1 Establish relative safety; 2 Support exploration and acceptance of sensation; 3 Establish pendulation and containment	Client can find and stay with at least one pleasant, neutral or supportive sensation, and can shift attention between activation and that resource	Client moves attention between a difficult sensation and a resource without flooding, and settles again within the session
B. Titrated processing	4 Titration; 5 Corrective experience (active defence replaces collapse); 6 Uncouple fear and helplessness from immobility; 7 Discharge survival energy	Small "drops" of trauma-linked activation are processed; thwarted defensive impulses are completed; immobility is explored without terror	Activation rises and resolves (discharge, then settling) in repeated small cycles; the client reports less fear of their own sensations
C. Integration and re-engagement	8 Self-regulation and "dynamic equilibrium" / relaxed alertness; 9 Orient to the here and now and re-establish social engagement	The client can self-regulate in daily life and re-connects to people and surroundings	Fewer triggers in daily life (e.g. in Payne's case, traffic sounds stopped bothering the client), plus stable sleep, mood and engagement

Every session runs through the same micro-cycle (the order is taken from Payne et al.'s case): observe the client's arrival and nervous-system cues → establish resources and social engagement → invite attention to pleasant or neutral body sensation → approach the trauma indirectly through a peripheral or neutral detail → titrate (raise activation slightly, monitor) → allow discharge and watch for pendulation → return to resources and settle → close by looking ahead to the client's week. [source: Payne et al. 2015]

Session count and format. Sessions are individual and usually face to face, with the client seated. In Payne et al. the client chooses the chair. In the Brom et al. (2017) randomised trial, adults with PTSD had 15 weekly SE sessions. Levine's filmed case "Ray" ran over five sessions. Session length is not given in the sources; around 50–60 minutes is typical but [uncertain]. Course length depends on the client: one-event ("shock") trauma in a resourced client may need few sessions, while early, developmental or chronic trauma needs a longer phase A. [source: Brom et al. 2017 abstract; TPC review; Wikipedia] [synthesis for the last point]

Within-session move criteria (from the case): approach a trauma detail only after the client can feel a resource. Stop raising activation when signs of flooding appear (breath speeding up, re-immersion in the event, loss of contact with the room) and go back to orienting and resources. Close only once the client has settled. [source: Payne et al. 2015]

3. Guiding principles

[source for 1–9: Levine 2010 via Goodreads highlights; Payne et al. 2015. Source for 10–15: Payne et al. 2015, Wikipedia, NICABM excerpt, as tagged]

Relative safety first. Nothing trauma-related is approached until the client has an "island of safety" (Levine). In practice: spend the first part of the session, and if needed whole sessions, on arrival, choice and resources.
Sensation is the main route. Attention to inner sensation, posture and movement comes before story and interpretation. In practice: ask where and how the client feels something, not why.
Pendulation. Levine holds that the organism naturally moves between contraction and expansion. In practice: deliberately alternate between activation and resource, and trust (and track) the client's own return toward settling.
Titration. Touch only the smallest "drop" of survival arousal at a time, to avoid retraumatisation. In practice: always choose the less intense entry point, and slow down when in doubt.
Active over passive. Replace collapse and helplessness with an experience of effective defence. In practice: look for, and support, small impulses to push, turn, brace or run.
Immobility is time-limited. Separate the conditioned fear from the freeze state. In practice: explore the frozen or heavy sensation itself, slowly, with curiosity, rather than avoiding it.
Discharge is welcomed, not produced. Trembling, warmth, tears, sighs and yawns are allowed and normalised. They are never pumped up or forced. In practice: name it as natural, slow it if it grows fast, and let it run its course.
Self-regulation is the goal, not catharsis: relaxed alertness ("dynamic equilibrium"). In practice: judge a session by whether the client ends settled and present, not by intensity.
End in the here and now and in contact. Re-establish orienting and social engagement. In practice: finish by looking around the room, eye contact and voice contact.
Avoid direct, intense evocation of trauma memory (this is where SE differs from exposure). In practice: no full narrative and no reliving. Approach from the edges. [source: Payne et al. 2015]
The therapist's observations are tentative. Interpretations are offered as provisional ("I imagine…") and revised. In practice: check your perception against the client's experience. [source: Payne et al. 2015]
Agency and choice. Small choices (seat, pace, eyes open or closed) rebuild agency. In practice: offer choices often, and accept "no". [source: Payne et al. 2015; NICABM excerpt]
Regulated presence. The therapist's warm, calm voice, eye contact and steadiness support the client's social-engagement (ventral vagal) system, in SE's polyvagal framing. In practice: regulate yourself first and slow your speech. [source: Payne et al. 2015]
Explain the method. Clients often find it counter-intuitive not to "talk about the accident". In practice: say why resources come first. [source: Payne et al. 2015]
Don't suppress, don't push. Pushing feelings down is unhelpful, and so is pressing clients to open up before they are ready. In practice: allow what comes, and do not go after content. [source: Payne et al. 2015]
Experience has a beginning, middle and end. Levine stresses "that there is an end". In practice: help the client feel each wave subside, and point out when it has. [source: NICABM excerpt]
Coupling. In SE's SIBAM model (see §4), arousal in one element of experience can over-trigger or shut down others. In practice: notice which channels are fused (overcoupled) or missing (undercoupled), and work to separate or reconnect them. [source: Wikipedia] [uncertain: primary description]

4. Intervention inventory

The items below are the procedures named or shown in the sources. SE is taught experientially over a multi-year training, and its training manuals were not available. Step detail beyond what the sources show is marked [synthesis]. All example wording is illustrative unless it is quoted and cited. Before starting, screen for: active suicidality, psychosis or mania, severe dissociation or dissociative identity presentations, current danger (e.g. ongoing domestic violence), cardiovascular or respiratory illness, epilepsy, pregnancy, recent injury or surgery, and substance intoxication. With any of these, keep to Phase A (safety, orienting, resources) and coordinate with medical and psychiatric care. Do not deliberately raise activation. [synthesis: the SE sources give no formal contraindication list]

4.1 Explaining the approach (psychoeducation)

Purpose / when: First session, and whenever the client asks "when do we talk about it?". It builds collaboration and lowers the fear of sensations. [source: Payne et al. 2015]
Steps: (1) Say briefly that trauma is understood as stuck survival activation, not as a personal failing. (2) Explain that you will build resources first and approach difficult material a little at a time. (3) Name the reactions that may come (trembling, warmth, tears, yawning) and say they are natural. (4) Say that the client sets the pace and can stop at any time. [source: Payne et al. 2015; steps 1 and 4 phrased as synthesis]
Example language (illustrative): "We won't go straight into the accident. First we'll find what helps your body feel a bit steadier. Then we'll touch the difficult part in small pieces, and come back to steady each time."
Watch for: the client agreeing on the surface while expecting catharsis. Check what they expect. It is working if the client stops pushing toward the story and grows curious about sensation.

4.2 Establishing relative safety, choice and agency (Building block 1)

Purpose / when: At the start of every session. It is the foundation for every other step. [source: Levine 2010 via Goodreads; Payne et al. 2015]
Steps: (1) Notice how the client arrives: gait, posture, breath, jaw, eye movement. (2) Offer concrete choices: chair, distance, door in view, eyes open or closed. (3) Invite the client to take time to settle into the seat. (4) Keep your voice slow and warm and use eye contact, adjusted to what the client can tolerate. (5) Help the client feel that each piece of work has a beginning, middle and end. [source: Payne et al. 2015; NICABM excerpt for step 5]
Example language (illustrative): "Take a moment to see where you'd like to sit. You can move the chair if that feels better."
Watch for: compliance without real choice ("whatever you want"). If you see it, offer two concrete options. It is working if the client makes a choice and their shoulders, breath or gaze settle a little.

4.3 Tracking and tentative observation

Purpose / when: All the time. It lets you read activation and settling moment to moment. [source: Payne et al. 2015]
Steps: (1) Watch breath rate and depth, skin colour, muscle tension (jaw, shoulders, hands), posture shifts, eye movement and swallowing. (2) Offer what you see as a tentative hypothesis ("I imagine…", "I notice…, I wonder…"). (3) Ask the client to check it inside. (4) Revise based on their answer. [source: Payne et al. 2015] [step 1 list partly synthesis]
Example language (illustrative): "I notice your hands have gone quite still. I imagine there might be some holding there. What do you notice?"
Watch for: imposing your reading on the client. Drop observations they do not recognise.

4.4 Resourcing

Purpose / when: Before approaching any trauma material, and as the place to come back to throughout. It builds embodied feelings of safety, comfort and strength. [source: Payne et al. 2015; Wikipedia]
Steps: (1) Find a resource. It can be external (a person, pet, place, activity, the chair, the room) or internal (a part of the body that feels comfortable or neutral, a memory of competence). (2) Ask where in the body the client feels the resource now. (3) Help them describe its qualities: heaviness, warmth, width, breath, support. (4) Give them time to stay with it, and let it deepen. (5) Mark it as a place to return to later. In Payne et al.'s case, the therapist guides attention to relief, heaviness and warmth as the client settles into the chair. [source: Payne et al. 2015] [step 1 categories and step 5: synthesis]
Example language (illustrative): "As you think of your garden, what do you notice in your body right now?" / "Where do you feel that warmth most? … Take your time with it."
Watch for: a resource that turns into grief or a trauma link (in Payne et al., sadness came up during relaxation). Support it gently without pressing further. If the resource collapses, choose a simpler, more concrete one (feet on the floor, the back of the chair). It is working if breath slows, posture softens, colour returns, and the client can find the resource again on their own.

4.5 Supporting exploration and acceptance of sensation; felt-sense tracking (Building block 2)

Purpose / when: In early sessions, and whenever a client fears their own body. It builds interoceptive tolerance. [source: Levine 2010 via Goodreads; Wikipedia (felt sense, from Gendlin)]
Steps: (1) Ask the client to notice any sensation and describe it in plain sensory words (location, size, temperature, pressure, movement, texture). (2) Start with pleasant or neutral sensations, then move to difficult ones. (3) Keep your questions open: what, where, how. Avoid "why". (4) Follow how the sensation changes over time ("and as you notice it, what happens next?"). (5) If it rises fast, move to pendulation (4.6) or orienting (4.13). [source: Payne et al. 2015 for step 2] [steps 1, 3, 4: synthesis consistent with sources]
Example language (illustrative): "If you look inside, is there a place that feels okay, or even just neutral?" / "Tight like a fist, or more like a band? … And what happens as you notice it?"
Watch for: sensation turning straight into story or self-criticism. Bring the client back to sensory description. It is working if the client can describe sensations with some curiosity and notice that they change.

4.6 Pendulation (Building block 3)

Purpose / when: Once a resource is available. It teaches the nervous system to move between contraction and expansion, and shows the client that difficult states pass. [source: Levine 2010 via Goodreads; Payne et al. 2015]
Steps: (1) Help the client find the place of distress or activation in the body. (2) Help them find an "opposite" sensation, posture or movement: somewhere less frozen, more powerful or more at ease (Levine's suggestion). (3) Guide attention gently back and forth: distress for a moment, then the resource for longer. (4) Over time, let the client's own rhythm lead. Levine and Payne describe pendulation as arising naturally when the process is supported. (5) Point out any spontaneous shift toward settling. [source: Goodreads highlights of Levine 2010; Payne et al. 2015] [timings: synthesis]
Example language (illustrative): "Notice the tightness in your chest just for a moment… now let your attention go to your hands resting on your legs, where it feels steadier… and when you're ready, check the chest again. What's there now?"
Watch for: getting stuck at either end. Too much time in activation risks flooding. Only resource and never contact means nothing gets processed. Payne et al. note that too much of either interrupts rebalancing. It is working if the distress softens or shrinks on each return, and the client begins moving between the two by themselves.

4.7 Containment through self-holding (Building block 3)

Purpose / when: When emotions or sensations feel boundless or overwhelming. Also, according to Levine, at bedtime for sleep and nightmares. This is self-touch only. Levine describes the body's outer surface (shoulders, sides of the chest) as a "container" that makes inner sensation feel less overwhelming. [source: NICABM excerpt (Levine)]
Steps (sequence 1): (1) The client sits comfortably. (2) They place the right hand under the left arm, on the heart side. (3) They place the other hand on the shoulder. (4) They notice the sensation in the hands, and what happens inside the body. [source: NICABM excerpt]
Steps (sequence 2): (1) One hand on the forehead, the other on the upper chest. (2) Eyes open or closed, whichever feels safer. (3) Wait, noticing any energy flow or change of temperature, until there is some kind of shift. Levine says this can take a few moments or five to ten minutes. (4) Keep the lower hand on the chest and move the upper hand to the belly. (5) Wait again for a shift or a sense of flow. [source: NICABM excerpt] To close, invite the client to lower the hands slowly, look around the room and describe what they notice now. [synthesis]
Example language (illustrative): "You might try resting one hand under the opposite arm and the other on your shoulder, just noticing what your hands feel… There's no right result."
Watch for: some clients find self-touch uncomfortable or triggering, especially after interpersonal or sexual trauma. Offer a no-touch alternative, such as feeling the back of the chair or pressing the feet into the floor. [synthesis] It is working if the client reports warmth, flow, slowing or a sense of being held, and the client can do it alone between sessions.

4.8 Titration: approaching trauma from the periphery (Building block 4)

Purpose / when: Once resources and pendulation are in place. It processes trauma-linked activation in small "drops" without flooding. [source: Levine 2010 via Goodreads; Payne et al. 2015]
Steps: (1) Choose a peripheral, low-charge entry point near the event, not the worst moment. In Payne et al.'s case the client is first asked to recall the weather that morning. (2) Ask what the client notices in the body as they touch that detail. (3) Stay with the sensation that comes up (in the case, tension and a tremor in the hands). Do not push through it. (4) Let activation peak and pass. Track discharge (4.10) and settling. (5) Go back to the resource. (6) In later cycles or sessions, move gradually closer to the core of the event: getting into the car, then the moment the truck slid. [source: Payne et al. 2015]
Example language (illustrative): "Let's touch just the edge of it. What was the weather like that morning? … And as you remember that, what happens in your body?"
Watch for: speeding breath, a fixed stare, the client talking as if they are back in the event. These signal the start of the "trauma vortex" (4.13), so drop to a smaller dose. It is working if activation rises a little, resolves, and leaves the client calmer than before. In the case, traffic sounds no longer bothered the client afterwards.

4.9 Working with SIBAM and coupling dynamics

Purpose / when: To map how a trauma is held across channels of experience, and to find where to intervene. SIBAM = Sensation, Image, Behaviour, Affect, Meaning. Levine also uses it as a model of dissociation. [source: Wikipedia] [uncertain: primary text]
Steps: (1) While tracking, note which channels are present: sensations, images, movements and posture, emotions, beliefs. (2) Look for overcoupling, where one element automatically fires others (e.g. a slight chest pressure brings instant panic and the belief "I'm dying"). Slow it down and separate the elements, so that sensation can be felt as sensation. (3) Look for undercoupling, where elements are missing or split off (e.g. a vivid story told with no felt sensation or emotion). Gently invite the missing channel ("as you tell me this, what do you notice in your body?"). (4) Work with one link at a time, titrated. [source: Wikipedia for the over/undercoupling concept; steps and examples: synthesis]
Example language (illustrative): "Let's stay just with the pressure for a moment, before the thought about what it means. What's the pressure itself like?"
Watch for: turning this into intellectual analysis. Keep it experiential. It is working if channels separate (sensation without automatic panic) or reconnect (felt emotion appears in place of flat narration).

4.10 Supporting discharge (Building block 7)

Purpose / when: When spontaneous trembling, shaking, heat, sweating, tears, sighing, yawning or small postural shifts appear. In SE's theory these mark activation resolving and the system returning toward baseline. [source: Payne et al. 2015; Levine 2010 via Goodreads; Wikipedia]
Steps: (1) Name the reaction calmly and say that it is natural. (2) Invite the client to let it happen without stopping it or making it bigger. (3) Keep them in contact with a resource or with the support of the chair. (4) If it speeds up or the client becomes afraid, slow it down: ask them to feel their feet, open their eyes, look around. (5) Wait until it subsides. Levine notes that deeper, slower breathing often follows. (6) Help them feel the settled state afterwards. [source: Payne et al. 2015 for steps 1–3 and the shaking spreading then releasing with tears and sighs; Levine 2010 via Goodreads for step 5] [step 4: synthesis]
Example language (illustrative): "That shaking is your body's way of letting go of some of that energy. You don't need to do anything with it, just let it be there… and notice the chair under you."
Watch for: this is not cathartic discharge. Do not prompt hitting, screaming, or hyperventilating to produce release. That runs against titration. Watch also for shaking that escalates into panic or dissociation. It is working if the trembling resolves into calm, warmth and easier breathing, and the client feels relief, not exhaustion. [synthesis for the caution]

4.11 Completing thwarted defensive responses: the corrective experience (Building block 5)

Purpose / when: When a movement impulse appears that the client could not carry out at the time of the event (e.g. turning away, pushing, bracing, running). The aim is to replace collapse and helplessness with an experience of effective action. [source: Payne et al. 2015; Levine 2010 via Goodreads]
Steps: (1) While titrating toward the moment of threat, watch for micro-movements: tension in the shoulders, a twist of the body, hands starting to move. In the case, shoulder tension and a twisting of the body appeared as the client recalled the truck sliding. (2) Slow everything down. (3) Invite the client to sense the impulse, and to let the movement happen very slowly, at their own pace. In the case this was the wheel-turning movement he could not complete during the crash. (4) Let the movement run all the way to its end. (5) Allow the settling that follows (relaxing, sighing). (6) Ask what the client did, so they register the action as their own. [source: Payne et al. 2015]
Example language (illustrative): "Your shoulders seem to want to turn. Let's go really slowly… let your arms find what they wanted to do then, as slowly as you like… What did you just do?"
Watch for: fast, flailing or forced movement means too much charge, so slow it or return to the resource. Do not script the movement for the client. Follow their impulse. It is working if the movement is completed with a sense of power or relief, and is followed by spontaneous calming.

4.12 Uncoupling fear and helplessness from immobility (Building block 6)

Purpose / when: When a client experiences freeze, collapse, numbness or heaviness, and dreads those states. Levine holds that immobility is time-limited and that fear of it keeps it going: "Fear begets paralysis, and fear of the sensations of paralysis begets more fear." [source: Levine 2010 via Goodreads]
Steps: (1) Help the client stay present with the frozen, heavy or numb sensation for a short, titrated time, instead of avoiding it. Levine suggests moving toward the fear and exploring the immobility itself. (2) Help them notice that it changes and passes. (3) Pendulate to a place or posture that feels less frozen and more powerful. (4) Name that the immobility was a protective state that ends. [source: Levine 2010 via Goodreads] [step 4 wording: synthesis]
Example language (illustrative): "Can you be curious about the heaviness, just for a few breaths, knowing we can move away from it any time? … What happens to it as you watch?"
Watch for: sliding into deeper shutdown (glazed eyes, faint voice, no response). Move straight to orienting (4.13). It is working if the client can feel the immobility without panic, and it gives way to small movement, warmth or breath.

4.13 Interrupting the trauma vortex and reorienting (Building block 9)

Purpose / when: When the client is being pulled into reliving. Payne et al. call this the "trauma vortex": body sensations from the memory set off more activation and can lead to dissociation within seconds. Orienting is also used routinely to close any piece of work. [source: Payne et al. 2015; Levine 2010 via Goodreads]
Steps: (1) Interrupt firmly and kindly. (2) Ask the client to open their eyes and look around the room. In Payne et al., the client is asked to name three things he sees. (3) Then guide attention to physical contact: the chair under them, the feet on the floor. (4) Re-establish contact with you through voice and eye contact. (5) Resume only with a much smaller dose, or not at all in that session. [source: Payne et al. 2015] [step 5: synthesis]
Example language (illustrative): "Let's pause here. Open your eyes and look around the room. Tell me three things you can see… Now feel how the chair is holding you."
Watch for: the client apologising or feeling they "failed". Normalise it. It is working if breath slows, eye contact returns, and the client can say where they are.

4.14 The "voo" sound

Purpose / when: A self-regulation exercise from Levine (2010) that uses breath and vibration to bring attention into the belly. It helps when the client feels agitated, frozen or disconnected from the inside of the trunk, and it can be taught for home use. [source: Goodreads highlight of Levine 2010]
Steps: (1) The client sits comfortably. (2) They inhale slowly and pause briefly. (3) On the out-breath they gently make a long, low "voo" sound, felt as a vibration from the belly. (4) They let the sound and breath run out fully, pause, and wait for the next breath to come and fill the belly and chest by itself. (5) They repeat several times, then rest, with attention on the abdomen and the inner cavity that holds the organs. [source: Goodreads highlight of Levine 2010 (paraphrased)] (6) The therapist asks what the client notices and follows up as in 4.5. [synthesis]
Example language (illustrative): "Let the sound come from low down, like it's vibrating in your belly… then just wait for the next breath to arrive on its own."
Watch for: forcing the breath or making the breath faster. Levine stresses waiting for the breath to come. Stop if the client feels dizzy, and screen respiratory conditions first. Some clients feel self-conscious making the sound. Doing it with them can help. It is working if the breath deepens and slows, and the client feels warmth or vibration in the belly and a sense of calm. [synthesis for cautions]

4.15 Integration: meaning and appraisal

Purpose / when: After a processing cycle. It links the bodily shift to understanding. Payne et al. note that faulty beliefs and appraisals are also addressed verbally, in ways close to cognitive restructuring. [source: Payne et al. 2015]
Steps: (1) Once the client has settled, ask them to describe what happened and what they did. (2) Invite any new meaning that comes up without being prompted (e.g. "I did try to save myself"). (3) Address unhelpful beliefs that remain (self-blame, "I'm broken") in conversation. (4) Link the change to daily life. [source: Payne et al. 2015 for 1 and 3] [2 and 4: synthesis]
Example language (illustrative): "What do you make of what your body just did?"
Watch for: interpretation coming too early, which pulls the client out of sensation. It is working if a new meaning arises from the client and fits the felt shift.

4.16 Self-regulation and session closure (Building block 8)

Purpose / when: At the end of every session. The aim is relaxed alertness, or "dynamic equilibrium". [source: Levine 2010 via Goodreads; Payne et al. 2015]
Steps: (1) Go back to the resource and orient to the room. (2) Check that the client is settled and present. (3) Look ahead to the coming week: possible triggers, and what to do (self-holding, voo, orienting). (4) Prepare for the next session. [source: Payne et al. 2015] [specific home practices: synthesis drawing on 4.7 and 4.14]
Example language (illustrative): "Before you go, how does your body feel right now compared with when you came in? … What might come up this week, and what could you do if it does?"
Watch for: clients leaving still activated or spaced out. Extend the closing, or arrange a check-in. It is working if the client leaves oriented and can name one resource to use.

4.17 Therapist touch [uncertain]

What the sources say: Practitioners and clients name touch as a key method-specific factor in SE. Levine often uses touch in his filmed work, and he says the interventions shown need further training. The TPC reviewer adds that counsellors who use touch need advanced bodywork training, and that touch must be covered in informed consent. SE International lists a dissertation on touch and movement in SE (Gomes 2014), but it is not drawn on. Where the hands go, how touch is applied and the touch protocols taught in SE training are not given in the sources. They are not described here and must not be improvised. [source: Wikipedia (citing Kuhfuß et al. 2021); TPC review 2015; SE International research page]
Consent framework if you are trained in touch [synthesis; sources give only the informed-consent requirement]: (1) Explain the purpose and the exact location of any touch before offering it. (2) Ask permission explicitly each time, and accept no without question. (3) Offer an equal no-touch alternative: self-holding (4.7), a cushion held by the client, or contact with the chair or floor. (4) Agree a stop word or signal. (5) Check in during the touch ("is this still okay?"). (6) Afterwards, debrief how it felt. (7) Record consent in your notes. Use only non-intimate areas, and never sexual or genital touch. Touch requires specific training and supervision. Check what your licence, professional code, employer and jurisdiction allow before using any touch.
Watch for: freezing, people-pleasing or consent that seems automatic (common after interpersonal trauma). Stop and go back to talk and self-touch.

Items not given in the sources

The following are often associated with SE in secondary material, but no primary description is drawn on here. They are therefore not set out as procedures here: named interventions for specific trauma types (falls, medical procedures, motor-vehicle accidents taught as modules), boundary exercises, and work with early developmental trauma. [uncertain] Levine's Healing Trauma (2005), a self-help programme with audio exercises, is not drawn on. [uncertain]

5. Handling problems

Client wants to tell the whole story or "get to it" [source: Payne et al. 2015]: In Payne et al.'s case the client asks when they will discuss the accident, and the therapist explains why resource work comes first. Respond by acknowledging the wish, explaining titration, and agreeing that the story will be approached in pieces. If the client is talking fast, slow them down by asking what they notice in the body as they speak. [synthesis for the last step]
Flooding / overwhelm / trauma vortex [source: Payne et al. 2015]: Stop the content. Orient the client to the room (name three things they see), then to the chair and feet, then to your voice. Next time, start from a smaller, more peripheral detail. If flooding happens again and again, go back to Phase A for several sessions. [synthesis for the last point]
Shutdown, collapse or dissociation (hypo-arousal) [synthesis, using 4.12–4.13]: Use the client's name, a slightly more energetic voice, and eyes open. Invite gentle orienting movements of the head and eyes, pressing the feet into the floor, or noticing the back against the chair. Do not explore immobility (4.12) until the client can stay present. If dissociation is severe or structural, work in a phase-oriented trauma framework and get specialist supervision.
No sensation / "I feel nothing" [synthesis]: Start from the outside in: the contact of the chair, temperature on the skin, the weight of the hands. Accept "neutral" as a finding. Use movement (small shifts, the voo sound) to bring sensation in. Treat numbness as information (possible undercoupling or shutdown), not as failure.
Resource turns negative [source: Payne et al. 2015 (sadness emerging during relaxation); response: synthesis]: Support the feeling without pushing it further. If it becomes too much, move to a simpler sensory resource. Some clients find relaxation itself threatening. Keep the resource small and keep the eyes open.
Discharge that escalates [synthesis]: Slow it down: eyes open, feet on the floor, slower breath out, contact with you. Reassure the client that the reaction is natural, and keep it within tolerable limits. Never amplify shaking or tears to "get it out".
Cognitive takeover or intellectualising [synthesis]: Acknowledge the thought, then ask where the client notices it in the body. Use cognitive work at the integration stage instead (4.15), as Payne et al. describe. [source for the integration point: Payne et al. 2015]
Resistance / guardedness / ruptures [source: Payne et al. 2015 for the case's prior anger at a talk therapist; response: synthesis]: Treat guardedness as protective, and work with the bracing itself as sensation if the client agrees. Use more choice and tentative language. If a rupture follows an intervention that felt too much, say so openly, take responsibility for the pace, and agree a smaller step next time. Repair is itself an experience of safe social engagement.
Non-adherence with home practice [synthesis]: Reduce it to one small, enjoyable practice (one self-hold at bedtime, three voo breaths). Link it to an existing routine. Explore what got in the way without judgement.
Activation between sessions [synthesis, extending Payne et al.'s closing step]: Warn the client that sleep, dreams or emotions may shift for a day or two. Give self-holding, voo and orienting as home tools. Agree when to contact you. If the client is repeatedly destabilised, slow the pace of processing.
Touch-related problems [synthesis]: If the client freezes, complies too readily or later reports discomfort, stop the touch, debrief, and offer only self-touch or no-touch options. Write it up, and take it to supervision.
Medical symptoms [synthesis]: Chest pain, fainting, seizures and similar symptoms need medical assessment, not an SE interpretation. SE is not a treatment for physical disease. Levine and Kline's work on pain concerns trauma-linked pain alongside medical care. [uncertain]
Suicidality or self-harm emerging [synthesis, standard practice]: Pause the body work. Do a structured risk assessment and collaborative safety planning (including lethal-means counselling about secure storage or removal). Increase contact or step up care as indicated. Restart SE only at the stabilisation level once risk is managed.
Clinician's own activation [source: Payne et al. 2015 (the therapist's calm presence); synthesis]: Track your own body. Your own regulation is the base the client co-regulates from. Use supervision, and personal SE sessions as required in training.

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