Somatic trauma therapy (Rothschild)

1. Introduction

Version followed: Babette Rothschild's no-touch Somatic Trauma Therapy as she sets it out in the article "Making trauma therapy safe" (Self & Society 27(2), 1999), The Body Remembers (2000; summaries and publisher descriptions only), 8 Keys to Safe Trauma Recovery (2010; chapter list only) and The Body Remembers Volume 2 (2017), now reissued as Revolutionizing Trauma Treatment (2021; descriptions and the PESI seminar objectives only). Where the 1999 article and the later books differ, the later emphasis is named. Exercise details come mainly from the 1999 article.

This is not a closed, manualised therapy. Rothschild (MSW, LCSW; a body psychotherapist since 1976, trained in Copenhagen) describes a set of principles and body-based tools that any trauma therapist can add to their existing model. Her publishers describe the techniques as "non-touch": the therapist does not touch the client, and the only touch is clients touching themselves or objects. [source: Somatic Perspectives bio; WUJ publisher page for Ciało pamięta]

How change happens: Rothschild holds that trauma is kept as implicit, body-level memory and as autonomic nervous system (ANS) arousal. Recovery depends less on going back over memories than on the client learning to notice and regulate arousal, the "brakes", while keeping dual awareness: knowing that the past is past while feeling its traces in the present. Processing memories is optional. In the later work she argues that many people with PTSD recover without ever revisiting their memories, provided their nervous system is brought back into balance and stabilised. [source: Rothschild 1999; Norton/AUT and Bookmate descriptions of Vol. 2; 8 Keys Key 3 title "Remembering Is Not Required"]

2. Framework

Rothschild gives no fixed number of sessions and no rigid phase manual. The sequence below follows her rule of brakes before accelerator, together with the ten foundations. The phase labels are [synthesis]; the content and the criteria for moving on are hers.

Format. Individual, sitting or standing, talk-based with body awareness and simple movements woven in. No massage table and no therapist touch. Length depends on the client: building dual awareness "may take weeks, months, or years" (paraphrase of Rothschild 1999). [source: Rothschild 1999]

Phase A: Safety, contact and contract.

Goals: check that the client is safe inside and outside therapy (living situation, triggers, current coping), build good contact before any trauma material, and agree a contract and a treatment plan that sets out the options, including recovery without memory processing. [source: ten foundations via SoBrief summary; PESI objectives on contracts and treatment planning]
Move on when the client feels safe enough in the room and the relationship can carry some discomfort. Rothschild says good contact comes before memory work even if building it takes months or years. [source: SoBrief summary]

Phase B: Brakes, resources and stabilisation (the core of the method, and for many clients the whole of it).

Goals: the client learns their own arousal signs, has at least several dependable brakes (body awareness, muscle tensing, sensory orientation, anchors, the flashback protocol), keeps dual awareness, and recognises and builds internal and external resources. [source: Rothschild 1999; counsellingtutor summary]
Move on (if memory work is chosen at all) once both client and therapist can reliably stop rising arousal and the client can stay dually aware while discomfort rises. If dual awareness is not yet possible, building it is the therapy. [source: Rothschild 1999]

Phase C: Optional, titrated trauma-memory work.

Goals: approach a memory in small steps, bringing in body awareness to accelerate a little, with the brakes always in reach. The aim is to lower the pressure, never to raise it. The therapist may use methods from other models (Levine's SIBAM, image manipulation, empty chair) inside this safety frame. [source: Rothschild 1999; SoBrief summary; 8 Keys Key 6 "Take Smaller Steps for Bigger Leaps"]
Criteria: work continues only while the client stays at manageable arousal levels. Signs of flashback or tonic immobility mean stop and stabilise before going on or ending the session. Rothschild's later work stresses predicting which clients will benefit from memory processing and offering alternatives to those who decline it or decompensate. [source: Rothschild 1999; PESI objectives]

Phase D: Consolidation and moving forward.

Goals: daily-life stabilisation, safe physical activity, working with shame and self-forgiveness, and finding meaning (8 Keys Keys 5, 7 and 8: "Reconcile Forgiveness and Shame", "Get Moving", "Make Lemonade"). [source: ICPL catalogue record of 8 Keys. The contents of these keys are not drawn on: [uncertain]]
Ending criteria [synthesis]: the client manages arousal and flashbacks on their own between sessions, and their agreed goals are met.

3. Guiding principles

Rothschild's ten foundations for safe trauma therapy (from The Body Remembers, 2000, read via a secondary summary [uncertain on exact wording]):

Establish safety in and outside therapy. In practice: assess home, relationships and triggers before you open any memory.
Develop good contact first. In practice: do no memory work until the alliance can hold distress, however long that takes.
Brakes before accelerator. In practice: never speed up a process that you and the client cannot yet stop.
Identify and build resources. In practice: list functional, physical, psychological, interpersonal and spiritual resources, and add to them.
Regard defences as resources. In practice: never strip a coping strategy away; add more choices next to it.
Reduce the pressure in the "pressure cooker". In practice: each intervention should lower arousal, not raise it.
Adapt the therapy to the client. In practice: draw on several models; when something fails, change the method, not the client.
Know the theory broadly. In practice: understand trauma psychophysiology well enough to predict effects and adjust techniques.
Do not judge non-compliance or failed interventions. In practice: treat failure as information about fit.
Be willing to drop technique. In practice: at times plain human contact is the intervention, and memory work may be left out altogether. [source: SoBrief summary of The Body Remembers]

Further principles from the catalogued sources:

Dual awareness is a precondition. In practice: the experiencing self and the observing self must both be present. If they are not, stop and rebuild. [source: Rothschild 1999]
Read the ANS continuously. In practice: watch breath, skin colour, pupils and stillness, and ask about heart rate and breathing at intervals. [source: Rothschild 1999]
Remembering is not required. In practice: offer recovery routes that do not involve memory processing, and let the client choose. [source: 8 Keys Key 3; Vol. 2 descriptions; PESI objectives]
Mindfulness as a navigation tool. In practice: noticing sensations, feelings, images and thoughts gives the client information for choices, including choices about treatment. [source: 8 Keys Key 1; Coopoly companion page (secondary)]
Test, don't assume. In practice: every body exercise is an experiment, judged by its effect on this client. The same tool can calm one client and stir up another. [source: Rothschild 1999]
Calm is not the same as relaxed. In practice: a client can have slack muscles while the nervous system is dysregulated. Track ANS state, not only muscle tone. [source: PESI objectives]
Tell hypoarousal from low arousal. In practice: trauma-related freeze or collapse is different from lethargy or depression, and each needs different handling. [source: Vol. 2 descriptions; PESI objectives]
No therapist touch. In practice: every somatic tool in this version is done by the client on their own body or with objects. [source: WUJ publisher description]

4. Intervention inventory

Touch and training note: in this version the therapist never touches the client. Where an exercise uses touch, it is the client touching their own body or an object. The consent steps below apply to these self-touch exercises. If you bring in therapist touch from another body school, you are outside Rothschild's version: that needs specific training, supervision, and a check of what your licence and jurisdiction allow. [source: WUJ description; [synthesis] for the training note]

General screening before any active body exercise [synthesis]: ask about pregnancy, cardiovascular or respiratory illness (sustained muscle tensing briefly raises blood pressure), epilepsy, recent injury or surgery, chronic pain, psychosis, severe dissociation and active suicidality, and adjust or leave out exercises to fit. Rothschild's own cautions are given with each technique.

4.1 Reading autonomic arousal (ANS monitoring)

Purpose / when: all the time, in every session. This is how you decide whether to brake, hold or go a little further. [source: Rothschild 1999]
Steps:
1. Learn the signs. Sympathetic: faster breathing and pulse, dilated pupils, pale skin that is cold or clammy, more sweating. Parasympathetic: slower, deeper breathing, slower pulse, constricted pupils, flushed warm skin. [source: Rothschild 1999]
2. Watch the client's breath, skin colour, pupils, sweating and stillness without commenting on them.
3. Every so often, ask the client what they notice about their heart rate and breathing.
4. Interpret what you see. Parasympathetic dominance means the pace is fine. Mild sympathetic arousal means excitement or discomfort the client can contain. High sympathetic arousal (racing heart, hyperventilation) means the client is struggling: brake. High sympathetic and high parasympathetic signs together (tonic immobility, frozen) suggest a flashback: stop and stabilise before going on or ending the session. [source: Rothschild 1999]
5. Later version: Rothschild's colour-coded table of six arousal levels (Vol. 2, 2017; laminated card) refines this. It separates trauma-related hypoarousal from the low arousal of lethargy or depression, and two kinds of freeze. [source: Norton/AUT and Bookmate descriptions; PESI objectives] The level names and criteria are not drawn on here [uncertain]. Use the published card for the exact levels.
Example language (illustrative): "Let's pause for a moment. What do you notice about your breathing right now? And your heartbeat: faster, slower, about the same?"
Watch for: pallor together with stillness and a fixed gaze (likely freeze), and a client who says they feel calm while their body shows high arousal. It is working when your read and the client's report agree more and more over the weeks.

4.2 Body awareness as a brake

Purpose / when: to ground and calm the client, at the start of a session, after upsetting material, or when the client is drifting. Rothschild notes it often lowers anxiety rather than raising it. [source: Rothschild 1999]
Steps:
1. Ask the client to notice, one at a time, their skin, muscles, breathing, temperature, areas of tension, pain or pressure, and heart rate. [source: Rothschild 1999]
2. Ask them to describe what they notice in plain words, with no right answer. Begin with neutral or peripheral areas [synthesis].
3. Check the effect: has arousal gone down, stayed the same or gone up?
4. If it went up, stop and switch to an outward-focused brake (4.13) [synthesis].
Example language: Counsellingtutor's paraphrase gives the prompt "What are you aware of in your body right now?" [source: counsellingtutor summary of Rothschild]. (Illustrative) "Notice where your back meets the chair. Is it warm or cool? Tense or loose?"
Watch for: Rothschild says avoid it when the trauma harmed the integrity of the body (for example injury, surgery or assault), because body focus may speed up contact with the trauma. Also avoid it when the client feels they must sense their body "correctly". [source: Rothschild 1999] It is working when breathing slows, colour returns, and the client reports more detail and less fear.

4.3 Body awareness as an accelerator (controlled)

Purpose / when: only once the brakes are reliable. Used on purpose to make contact with somatic memory a little at a time. [source: Rothschild 1999; SoBrief summary]
Steps: (1) Agree the target and the stop signal first [synthesis]. (2) Have the client name the trauma by title only, then notice the sensations that come up. (3) Go a short way, then brake (4.2, 4.4 or 4.13). (4) Alternate, keeping arousal manageable. (5) Close with a brake and a check of present-time orientation. [source: Rothschild 1999 for alternating brake and accelerator; step detail [synthesis]]
Example language (illustrative): "Just say the title, nothing more. What happens in your body? ... Let's put the brakes on now: feel your feet."
Watch for: a jump to high sympathetic arousal or freeze. Stop at once. It is working when the client can approach the memory and come back.

4.4 Peripheral muscle tensing (legs; left arm; right arm)

Purpose / when: a brake for clients who feel collapsed, fragmented, spacey or anxious. Building muscle tone in the limbs gives a sense of containment. Find out which muscles help this particular client. [source: Rothschild 1999]
Rules for all three: tense only until the muscle feels slightly tired; release very slowly; after each one, check with body awareness before trying the next; if tensing brings nausea, spaciness or anxiety, gently stretch the same muscle the opposite way to undo it. [source: Rothschild 1999]
Steps, legs: the client stands with feet a little less than shoulder-width apart and knees soft, then presses the knees outward until they feel tension along the outsides of the legs. They hold until slightly tired, release slowly and notice the effect. [source: Rothschild 1999]
Steps, left arm: sitting or standing, the client crosses the right arm over the left with the right hand covering the outside of the left elbow. They push the left arm outward, away from the body, against the resistance of the right hand, hold, release slowly and notice. [source: Rothschild 1999]
Steps, right arm: the mirror image, with the left arm crossed over the right. [source: Rothschild 1999]
Repetitions: the sources give no set numbers. Try one at a time and repeat what helps [synthesis].
Example language (illustrative): "Press out only until it's a little tiring, then let go as slowly as you can. What do you notice now? More solid, less, or no change?"
Watch for: see the general screening above for blood pressure and pain [synthesis]. It is working when the client reports feeling more solid, contained or present. Note which muscle groups help and give those as homework.

4.5 Dual-awareness statements

Purpose / when: when the client is caught up in a past feeling, in session or in daily-life triggers. Rothschild treats dual awareness as essential to any trauma work. [source: Rothschild 1999]
Steps:
1. The client names the feeling in the present tense (the experiencing self).
2. The client then names the present reality (the observing self), for example that there is no danger here and now.
3. Repeat until the second statement feels true in the body.
4. Practise in safe settings, then use it in real trigger situations. Rothschild's Copenhagen clients used it while waiting on the Nørreport station platform. [source: Rothschild 1999]
Example language: Rothschild's pattern pairs a feeling ("I'm feeling very scared here") with "But I'm not in any danger" [source: Rothschild 1999, short quotes].
Watch for: a client who cannot hold the second statement at all. Then building dual awareness becomes the focus of therapy, and it may take a long time. [source: Rothschild 1999] It is working when arousal falls as the present-reality statement is said.

4.6 Flashback halting protocol

Purpose / when: to stop a flashback or a strong trigger reaction while it is happening, and as practised self-help (8 Keys Key 4, "Stop Flashbacks"). [source: counsellingtutor summary; Rothschild 1999; ICPL record]
Steps (paraphrased structure):
1. The client names what they are feeling right now.
2. The client names several current body sensations (the summary gives three).
3. The client names what they are remembering, by title only, with no details.
4. The client describes what they can see around them now, including the current place and year, and concludes that the trauma is not happening any more.
5. Repeat as needed. Write it down for home use in the client's own words [synthesis]. [source: counsellingtutor summary; Rothschild 1999]
Example language (illustrative): "Say what you're feeling, then three things your body is doing, then just the name of the memory, and then tell me what you can see in this room today."
Watch for: clients who slip into telling the memory in detail; bring them back to the title. It is working when the flashback shortens and the client uses the protocol on their own. Rothschild's exact wording is not drawn on [uncertain]: use her published version (The Body Remembers, 8 Keys) in handouts rather than this paraphrase.

4.7 Skin boundary: self-rubbing

Purpose / when: for clients who feel unbounded, merged or unreal. It gives a felt sense of where the body ends. [source: Rothschild 1999]
Consent (self-touch): explain the exercise; ask whether it is acceptable; offer the no-skin alternative of pressing against a cool wall or door, a pillow or a towel; agree a stop word or gesture [synthesis]; check in during and afterwards [synthesis]. [source: Rothschild 1999 for the alternatives]
Steps: the client rubs their own skin firmly, neither too lightly nor too hard, starting with one spot and widening out, especially the back (or against the wall) and the sides of the arms and legs. The pressure stays on the skin surface, without gripping the muscles. Then pause and notice. [source: Rothschild 1999]
Example language (illustrative): "Rub along the outside of your arm, firm but comfortable. Then stop and notice the edge of your skin."
Watch for: Rothschild warns that some clients find this provoking. If so, stop and use an object-contact alternative. [source: Rothschild 1999] It is working when the client says something like "I can feel where I am."

4.8 Skin boundary: contact with objects

Purpose / when: the same aim as 4.7, with no self-touch. [source: Rothschild 1999]
Steps: the client senses where the buttocks meet the chair, the feet meet the shoes or floor, and the palms rest on the thighs, and pairs each point of contact with the phrases "this is me" and "this is where I stop". [source: Rothschild 1999, short quotes]
Example language (illustrative): "Feel where your feet touch the floor. Notice: this is me, and this is where I stop."
Watch for: a client who goes numb instead of becoming aware; switch to 4.4 or 4.13. It is working when the client feels more contained.

4.9 Feeling the solidity of the bones: spine

Purpose / when: a sense of inner support, for clients who feel they are collapsing or have no backbone. [source: Rothschild 1999]
Steps: the client sits or stands upright and senses the spine holding the trunk up, either by attention alone or by leaning the back against a wall, then notices the effect. [source: Rothschild 1999]
Example language (illustrative): "Let the wall hold your back for a moment. Can you feel your spine doing the job of holding you up?"
Watch for: Rothschild notes that for some clients bones bring up skeletons or death. Drop the exercise if so. [source: Rothschild 1999]

4.10 Bone tapping

Purpose / when: the same aim as 4.9, through vibration. [source: Rothschild 1999]
Consent (self-touch with an object): as in 4.7 [synthesis].
Steps: the client taps gently with a wooden spoon or pencil on bony points (elbow, wrist, knee, ankle), moving between the two ends of the same bone, and feels the vibration travel along it. [source: Rothschild 1999]
Example language (illustrative): "Tap lightly at your wrist, then at your elbow. Can you feel the bone carry the tap between them?"
Watch for: the same death or skeleton association as in 4.9. It is working when the client feels more solid.

4.11 Sensory orientation (exteroception) for instant stabilisation

Purpose / when: quick stabilisation in session and in daily life, and to deal with flashbacks and nightmares by moving attention to the outer senses. Useful when inward body awareness raises arousal. [source: PESI seminar objectives; counsellingtutor summary on exteroceptive vs interoceptive systems]
Steps [synthesis based on the sources' description; Rothschild's own step list [uncertain]]:
1. Ask the client to look around and name what they see: colours, objects, light.
2. Add the other senses: sounds in the room and outside, textures under the hands, temperature, smell.
3. Have the client name the date and the place.
4. Check arousal. Repeat or go on to 4.6.
5. For nightmares: on waking, the client turns on the light and names the bedroom's objects and the date before going back to sleep.
Example language (illustrative): "Look around and tell me five things you can see in this room. Now two sounds you can hear."
Watch for: the eyes glazing as the client names things automatically. Ask for more detail ("what colour is the book's spine?") [synthesis]. It is working when the client becomes more animated and present.

4.12 Anchors

Purpose / when: a brake taken from positive memories, people, places, objects or sensations, called up when arousal climbs during hard work. [source: SoBrief summary of The Body Remembers]
Steps [synthesis; detail [uncertain]]:
1. Before any trauma work, find with the client a real (preferably current) person, place, animal, object or activity that brings a felt sense of relief.
2. Explore it in sensory and bodily detail and note the body markers (breath, warmth, posture).
3. Practise switching to the anchor when arousal is low, then medium.
4. During later work, call the anchor up as a brake.
Example language (illustrative): "When you picture your sister's kitchen, what happens in your chest and breathing?"
Watch for: anchors that carry hidden trauma links (a person who was also a perpetrator). Check each one physically. It is working when calling it up reliably lowers arousal within a minute or two.

4.13 Safe place

Purpose / when: a brake or resource built from a real or remembered safe place and/or safe person. The SoBrief summary links it to a Bodynamic-derived exercise of imagining running to the safe place and person. [source: SoBrief summary; [uncertain] on its exact form in Rothschild's text]
Steps [synthesis]: (1) The client chooses a place they actually know, rather than a fantasy. (2) Explore its sensory and bodily features. (3) If the running variant is used: the client imagines running towards the safe place or person, and the therapist tracks the leg muscles and the sense of relief. (4) Close by returning attention to the room.
Example language (illustrative): "Picture yourself heading toward that place, where your grandmother is. What do your legs want to do?"
Watch for: clients who have no safe place at all. Never insist; use an object anchor (4.12) or 4.8 instead [synthesis].

4.14 Resource inventory and building

Purpose / when: from the start of therapy: to find and strengthen the buffers against traumatic stress, including resources not yet recognised. [source: ten foundations via SoBrief; PESI objective on "previously unrecognised resources"]
Steps: (1) Map the categories with the client: functional (job, home), physical (strength, health, exercise), psychological (intelligence, humour, creativity), interpersonal (people, pets) and spiritual. (2) Note the body sensations when each resource is recalled [synthesis]. (3) Choose one to strengthen each week [synthesis]. [source: SoBrief summary for categories]
Example language (illustrative): "What gets you through a bad day, even small things? Who or what is on your side?"
Watch for: clients who dismiss their resources. Ask about the specific things they did to survive. It is working when the list grows and is actually used.

4.15 Defences as resources (adding choices)

Purpose / when: whenever a coping strategy (avoidance, dissociation, control) shows up. [source: ten foundations via SoBrief]
Steps: (1) Name the defence without judging it. (2) Explore what it protected the client from. (3) Keep it, and add at least one more option for the same situation. (4) Let the client choose between them. [source: SoBrief for "never get rid of, add choices"; steps [synthesis]]
Example language (illustrative): "Spacing out kept you safe back then. Let's keep that option and find a second one you can choose when you want it."
Watch for: framing that sounds like the defence is being taken away. It is working when the client experiments with the new option without losing the old one.

4.16 Plot your course with mindfulness (Key 1)

Purpose / when: to teach the client to notice body sensations, feelings, images and thoughts as information, including in choosing interventions and therapists. [source: ICPL record; Coopoly companion page (secondary)]
Steps [synthesis]: (1) Brief noticing check-ins at set points in the session. (2) Before trying any intervention, ask the client to notice how they react to the idea of it. (3) Use that reaction to pick, adapt or decline the intervention.
Example language (illustrative): "Before we try this, notice what your body says to the idea: lean in, pull back, nothing much?"
Watch for: mindfulness that heightens distress (see 4.22).

4.17 Begin with your epilogue (Key 2)

Purpose / when: early on: starting from the fact that the client survived and the trauma ended. [source: ICPL record of the key title "Begin With Your Epilogue...You Made It!" [uncertain]]
Steps [synthesis based on the title only]: have the client describe when and where the trauma ended and what came straight after (being safe, being helped), and note the body sensations that come with that.
Example language (illustrative): "Before anything else, tell me about the moment you knew it was over."
Watch for: trauma that has not ended (ongoing abuse). Then safety comes first (Phase A).

4.18 Option-based treatment planning and the therapeutic contract

Purpose / when: at assessment and again at any turning point. Agree whether, when and how memory processing will be part of the work, and offer full recovery routes without it. [source: PESI objectives on contracts, treatment planning and predicting who benefits; Vol. 2 descriptions; 8 Keys Key 3]
Steps [synthesis]: (1) Set out the options: stabilisation and resources only; titrated memory work; referral for other memory-processing models. (2) Review the predictive factors together (dual awareness, reliable brakes, stable life situation, the client's wish). (3) Write the contract down, including the client's right to stop. (4) Review it regularly.
Example language (illustrative): "Many people get better without going back through the details. You decide whether we ever do that, and you can change your mind."
Watch for: a client who believes they have to tell everything. Correct this explicitly.

4.19 Titrated memory approach (smaller steps)

Purpose / when: Phase C, if chosen. [source: Rothschild 1999 on advancing slowly and returning to the brakes; 8 Keys Key 6 title]
Steps: (1) Pick one small slice of a memory, beginning before the worst point [synthesis]. (2) Approach it for a short time, with 4.1 monitoring throughout. (3) Brake. (4) Approach again, a little further only if arousal settles. (5) Close every session at manageable arousal; never send a client home in a flashback state. [source: Rothschild 1999]
Example language (illustrative): "We'll only go as far as the car pulling up. Then we stop and check."
Watch for: pressure building (the pressure-cooker image). Every step should lower the pressure over time.

4.20 Good memories and somatic markers

Purpose / when: using positive memories and the body states that go with them (somatic markers) as stabilising resources, including for clients who dissociate. [source: Norton/Bookmate descriptions of Vol. 2 [uncertain]]
Steps [synthesis]: (1) Bring up a specific good memory. (2) Track its body marker (warmth, an easy breath, posture). (3) Help the client recognise the marker so they can call it up again. (4) Use it as a brake or a closing resource.
Example language (illustrative): "As you remember that beach afternoon, where in your body do you notice it?"
Watch for: good memories that turn bittersweet (grief). Choose another, or work with it gently.

4.21 Telling arousal states apart: hypoarousal vs lethargy, relaxed vs calm

Purpose / when: whenever arousal is low or the client looks relaxed. Each state needs a different response. [source: Vol. 2 descriptions; PESI objectives]
Steps [synthesis; Rothschild's criteria [uncertain]]: (1) Note low arousal. (2) Ask whether it feels heavy and depressed, or frozen and numb with an alarm underneath. (3) Check for signs of sympathetic arousal mixed in. (4) Trauma-related freeze or collapse: use gentle activation and orientation (4.4, 4.11). Lethargy: use activity and motivation.
Example language (illustrative): "Is this a tired, heavy low, or more like being switched off while something inside is on alert?"
Watch for: relaxation exercises given to a frozen client, which can deepen the freeze [synthesis].

4.22 Adapting mindfulness, meditation, yoga and exercise (Key 7)

Purpose / when: when clients practise these, or are referred to them. Rothschild teaches how to adapt them for dysregulated clients with PTSD. [source: PESI objectives; 8 Keys Key 7 "Get Moving"]
Steps [synthesis]: (1) Ask how the client feels during and after practice. (2) Shorten the duration, keep the eyes open, use outward-focused attention or movement-based practice if inward focus raises arousal. (3) Choose physical activity the client enjoys and can stop at any time.
Example language (illustrative): "If sitting with eyes closed gets you agitated, try five minutes walking and noticing your feet instead."
Watch for: long silent sits that bring on flashbacks.

4.23 Forgiving limitations and sharing shame (Key 5)

Purpose / when: when shame or self-blame about how the client behaved during or after the trauma blocks recovery. [source: ICPL record: Key 5 parts A "Forgive Your Limitations" and B "Share Your Shame" [uncertain]]
Steps [synthesis]: titrate disclosure of the shameful content as in 4.19; watch the body for shame reactions (the gaze dropping, collapse); answer with steady acceptance; link limits to the survival responses of the ANS.
Example language (illustrative): "Freezing was your nervous system doing its job, not a choice you failed."

4.24 Make lemonade (Key 8)

Purpose / when: late in therapy: finding meaning or gain in what happened. [source: ICPL record of the title only [uncertain]]
Steps [synthesis]: only when the client is stable and asks for it; never forced positivity.

4.25 Using other models inside the safety frame

Purpose / when: Rothschild adapts the therapy to the client by drawing on several models: Levine's SIBAM (sensation, image, behaviour, affect, meaning) for tracking memory elements, image manipulation from NLP (changing the sensory qualities of an intrusive image), and the Gestalt empty chair for dialogue between parts. [source: SoBrief summary]
Steps: use each only with the brakes in place and arousal monitored (4.1). Stop if pressure rises. [source: Rothschild 1999 for the frame]
Example language (illustrative): "Let's make that picture smaller and further away, and see what your body does."

4.26 Presence without technique

Purpose / when: when techniques fail, or when the client needs contact more than intervention. [source: ten foundations via SoBrief]
Steps: put the technique aside, stay with the client, keep watching the ANS, and offer warmth and steadiness.
Example language (illustrative): "We don't need to do anything right now. I'm here."

Not found in the sources: Rothschild's physical-boundary and therapist-distance exercises, and her full touch guidelines, are not covered here [uncertain]. Consult The Body Remembers (2000) directly.

5. Handling problems

Overwhelm or rising hyperarousal in session. Brake at once: body awareness of a neutral area (4.2), muscle tensing (4.4) or sensory orientation (4.11). Do not go back to the material in the same session unless arousal is clearly back in the manageable range. [source: Rothschild 1999]
Flashback or tonic immobility (pale, frozen, fixed gaze). Stop all accelerating. Talk the client through the flashback protocol (4.6) and present-time orientation (4.11). Never send the client home in this state; extend the session or arrange support if needed. [source: Rothschild 1999; extension and support plan [synthesis]]
A body exercise makes things worse (nausea, spaciness, anxiety). For tensing, stretch the muscle the opposite way. For body awareness, switch to outward attention. Note the result as information, without blame. [source: Rothschild 1999; ten foundations]
Body focus is itself triggering (body-integrity trauma such as assault, injury or surgery, or a client anxious to "do it right"). Stay with external and object-based tools (4.8, 4.11), drop body-awareness work for now, and say explicitly that there is no correct sensation. [source: Rothschild 1999]
No dual awareness. Do not do memory work. Make dual-awareness practice (4.5) the treatment, for as long as it takes. [source: Rothschild 1999]
Stuck clients, or no progress in memory work. Go back to the contract (4.18). Consider whether this client is suited to memory processing at all, and offer the stabilisation-only route as a full recovery option, not a failure. [source: PESI objectives; Vol. 2 descriptions]
"Resistance" or avoidance. Treat it as a defence-resource (4.15): explore what it protects and add choices. Never push through it. [source: ten foundations via SoBrief]
Non-adherence to homework. Do not judge it. Assume the method did not fit, and change the exercise, its length or its setting. [source: ten foundations via SoBrief; adaptation detail [synthesis]]
Ruptures (the client sees the therapist as threatening, or the room as the trauma scene). Rothschild reports a workshop client who took the therapist for the perpetrator. The response is to stop at once and restore present-time orientation. [source: Rothschild 1999] Then [synthesis]: point out concrete differences between the therapist and the room and the past; give the client control over seating and the door; repair openly once arousal has settled.
Hypoarousal or collapse mistaken for calm. Check whether it is freeze or relaxation (4.21). Use gentle activation (tensing, standing, orientation) rather than more relaxation. [source: PESI objectives; activation choice [synthesis]]
Mindfulness or yoga outside therapy triggering symptoms. Adapt the practice (4.22) or suggest pausing it. [source: PESI objectives]
Client wants therapist touch, or expects it from body therapy. Explain that this method is no-touch and offer self-touch or object alternatives (4.7, 4.8). If touch is ever considered, it needs specific training, supervision and a check of the licence and jurisdiction. [source: WUJ description; rest [synthesis]]
Dissociation between sessions, self-harm or suicidality [synthesis]: carry out standard structured risk assessment and safety planning, including lethal-means counselling (safe storage or removal), crisis contacts, and more frequent sessions. Pause any memory work until the client is stable.
Ongoing danger (current abuse, unsafe housing) [synthesis, consistent with the safety foundation]: put safety planning and practical help before somatic work. Do not use trauma-memory techniques while the threat continues.
Therapist's own arousal [synthesis; Rothschild's Help for the Helper, 2006 [uncertain]]: watch your own breathing and tension, use the same brakes on yourself, and take overwhelming cases to supervision.

Sources

Sources:

Books cited (not drawn on in full):

Rothschild, B. (2000). The Body Remembers: The Psychophysiology of Trauma and Trauma Treatment. Norton.
Rothschild, B. (2003). The Body Remembers Casebook. Norton.
Rothschild, B. (2006). Help for the Helper. Norton.
Rothschild, B. (2010). 8 Keys to Safe Trauma Recovery. Norton.
Rothschild, B. (2017). The Body Remembers Volume 2: Revolutionizing Trauma Treatment. Norton (reissued 2021 as Revolutionizing Trauma Treatment: Stabilization, Safety, & Nervous System Balance).
Rothschild, B. Autonomic Nervous System Table (laminated card). Norton.

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