Episode 23: What is Somatic Therapy and How Can it Help Your Clients? with Sarah Berneche

Kayla: Welcome back to Your Clinical Supervisor’s Couch podcast, and I’m your host, Kayla Das.

In today’s episode, Sarah Berneche, Somatic Nutritionist and Intuitive Eating Counselor, will share how to help clients feel safe in their bodies using somatic therapy.

Hi Sarah, welcome to the show. I’m so glad to have you here today.

Sarah: Hi, Kayla. It’s so great to be here with you.

Kayla: Sarah, before we dive into today’s episode, please introduce yourself and tell us a little bit about your practice journey.

Sarah: Yeah, of course. So I am a Toronto-based nutritionist, intuitive Eating Counselor, and Somatic Experiencing Practitioner. And I’ve been doing this work for over 10 years. I specialize in eating disorders and body image concerns, as well as any food related concerns from a trauma-informed lens. And so that’s a little bit about me and my practice.

Kayla: what is somatic therapy and what does somatic experiencing entail. And how does somatic experiencing differ from somatic therapy? Or are they the same?

Sarah: Yeah, somatic therapy is a general umbrella for just somatic work, generally speaking, and when we’re talking about somatic work, we’re really talking about the body. So soma is a Greek word for body, and so we’re thinking about anything related to the body, generally speaking.

Somatic experiencing is a specific modality that was developed by Dr. Peter Levine. And essentially there’s all this work about how animals can essentially be overwhelmed, their systems can be overwhelmed. They can experience overwhelming situations, but they go back to baseline and they don’t tend to experience trauma in the same way as humans do.

And so when we’re talking about facilitating somatic therapy or somatic experiencing work with folks. It differs from cognitive behavioral therapy and some of these other cognitive modalities because rather than paying attention only to thoughts and behaviors, we’re really learning how to track sensation and helping folks to do that, and we’re paying attention to other content too. So any kind of images or symbols that come up. Specific types of gestures that they might experience during the session, and other responses outside of that. So it’s a very different model in that way.

Kayla: That makes sense. Why did you choose somatic experiencing as a therapy modality, say over cognitive based or behavioral based therapeutic approaches? And what’s your experience using this particular modality?

Sarah: I think that there’s space for all of it. I’m a student therapist as well as nutritionist in my nutrition and counseling practice. I use acceptance and commitment therapy. So that’s one potential model. And I also use some medical experiencing some parts work.

And in my actual therapeutic work, I use expressive art. I also use somatic experiencing. I think there’s room for all of it. The reason that I might use somatic experiencing over another model is because somatic work is where we go when other models have failed. So that’s number one. And so there are some clients that will not necessarily see results with cognitive type behavior work. So then we’re going into the somatic work so that they can actually get to where they want to go.

The other thing is I really pay attention to meeting a client where they’re at. And we often say that, but I don’t think that we actually look at what does that actually mean to meet a client where they’re at.

And certainly we’re talking about mirroring, I think about mirroring when I think about that. In terms of the language that we’re using, in terms of our behavior that we’re using. In terms of where they are in the stages of change. But also what is the response that they’re saying in the room? Like are they having thoughts or are they speaking in sensation? And so if a client is saying, I feel so uncomfortable, they’re speaking in sensation and somatic work is a way to meet them exactly where they’re at in the moment and to attune to them adequately as opposed to maybe we’re bringing in a model that’s misattuned for them. And so that’s one area where I might be using somatic experiencing and why I find it so helpful.

And then in terms of why I went in that direction as opposed to staying at the level of behavioral work. I just find it’s a really deep way of working with folks and a way of moving past management strategies into actual resolution.

Kayla: When it comes to somatic therapy, from your experience, when should somatic therapy be used? Because I know you mentioned, cognitive or behavioral or really any type of modality may not necessarily fit all clients. So what are some signs for therapists considering to use somatic therapy in their practice that they would like to keep an eye out for.

Sarah: I think that whenever we’re considering using a somatic modality, I think first and foremost, it’s important that we do the work on ourselves first and have a sense of our own nervous system. So if we’re unsure of our own nervous system map and how that shows up, it’s going to be really challenging to then work with clients.

So I think even if there’s any curiosity at all about incorporating somatic work, I think that to do the work justice. We really want to be thinking about how that shows up for us and having a sense of our own nervous systems.

And then secondly, I think things to look out for. I can only speak to the work that I have done, so I think about eating disorders, which of course are really complex management strategies. But one thing I think about are the clients who have been struggling for years and years, and we’ve seen this, right? Where there are some clients that seem to find stability within one to five years say. And there are clients that could be struggling for decades.

When a client has been struggling for decades. It’s reasonable to consider that they may have already done lots of CBT, DBT. They’ve gone through all of that. They’ve gone through likely outpatient programs. They’ve done residential treatment programs. And so now we’re looking at bringing in bigger, more powerful modalities. Like what I would argue are more powerful modalities to really address it because something’s not landing for them.

Once a client is extremely dysregulated, of course, like their information can’t land. So even though I can tell a client, Hey, if we’re not eating enough food, X, Y, Z can happen that’s not going to land because physiologically they’re running from a tiger. So we really want to be able to support them to feel safer in their body so that the work can actually happen. So one of the things I look out for is exactly that, what’s this client’s history? What have they have been doing before, and what’s happening now? Another thing to think about is their attachment history, their trauma history. I think about clients who’ve been through extremely traumatic situations might need more than again behavioral work. We might be eventually going into something more somatic, just depending on the client.

So I think those are two things off the top of one looking at the client’s history.

As well as what have they been trying in the past? What’s worked, what hasn’t worked so well? And maybe they are a client that will say to you like, nothing’s really worked for me. And that’s true for them. Maybe nothing really has given them sustainable support that they’re looking for the kind of stability that they’re looking for.

Kayla: Amazing. So thinking about how somatic therapy can be used to help clients feel safe in their bodies, how do you use it with that respect?

Sarah: Yeah. I think this is a really big question, but how do we help people to feel safer in their bodies? One, I think it begins with the relationship itself. I have a nervous system. You have a nervous system. And then we’re working together in the room and really helping to grow that relationship, grow that connection. I think that’s really what I think about as phase one. So whenever one, we’re thinking about the nervous system to nervous system connection.

I’m also thinking about, as a nutritionist, I’m thinking about. Is this person eating enough food? What is their sleep like? What is their home situation like? What is their social support like? Do they have enough stability there? So again, we’re thinking about Maslow’s hierarchy of needs and is that foundation supported for them so that they can continue moving forward? So I think about that piece, are the fundamentals taken care of? Because if someone’s not eating enough, it’s going to be very challenging to really get anywhere with the trauma work. Because at the root, they are automatically dysregulated due to a lack of nutrition. So I think about that piece.

And then I think where behavioral work can be really helpful of, addressing thoughts, addressing behaviors, addressing any associations with food as something that I think about if I believe that eating a cupcake will equal this, that, and the third, and that’s terrifying for me. I want to address that first before I go any further. What I consider like association work. We really want to support that piece of it.

And then slowly but surely, we’re going more and more to towards emotions and sensations and helping people to feel safer with that. And the ways that we might do that vary. So it could be that we use something called pendulation, which is, I’m going between what I experience as safety, and then going into a more challenging place. So if someone comes to me and they say, you know what? I would really love to be able to go for ice cream, but it terrifies me.

So I might say maybe we think about the ice cream and then we’re going in towards something else. It might just start on the outskirts of it, right? Just imagining going to get the ice cream. So we’re just thinking about it and doing that work. And then maybe we’re actually like looking up a place where we could get the ice cream and choosing a flavor and then working on it that way.

And then maybe it is. Going and getting a small amount, whether that’s a kitty cone or a smaller scoop of ice cream and starting that way. And so we’re doing it in this really titrated measured way so that each point they can say, okay, I was challenged and I can come back to baseline and feel safe enough again. And I was challenged and I come back to baseline again.

And so one that’s just a really lovely way of helping someone to move through the process and to take in a little bit. At a time that they can manage. And then continue to build capacity for more and more. And so when we’re talking about feeling safe, it is really those fundamentals as well as over time being challenged in really doable ways that they can handle so that we are building capacity and can handle more. And then as the capacity grows, as the window of tolerance grows, they are theoretically going to feel safer in their bodies.

Kayla: I love that. So for any listeners, how can they start integrating somatic principles in their work? In other words, are there simple somatic exercises that therapists can use in sessions when working with a client?

Sarah: I think so in addition to doing their own work, I really love a resource. It’s called Polyvagal Theory in the Therapy Room by Deb Dana. I love Deb Dana. I think she’s just accessible. Her work is really practical. And in that book, there are some exercises to get started. One I really love is her ladder exercise where you detail what takes you into sympathetic, what takes you into dorsal state, and what brings you back into regulation.

That’s what we call a nervous system map, so getting a sense of what’s going on there so that you do have more awareness over your nervous system. That can be really helpful for therapists and clients alike to see what is happening for this client and what’s really triggering for them.

That can be really revealing because we may not know, right? A client might say, this particular color is really triggering for me, or this, particular song is really triggering for me. And we would have no other way of knowing that. So it really gives us a sense of like, where is this client? And what might be the little minds for this client that might show up for us. And that’s really illuminating.

And in the same way, their response to what brings them back into regulation can also be really illuminating. For some clients, they have no idea what would help them to feel safer, the things that help them to feel safe, or actually things like, it could be, staying within their house helps them to feel safe. Not interacting with other people helps them to feel safe. So they’re really communicating their full window of tolerance and not what we might consider to be like genuine safety. So that gives us a sense, again, of where is this person on the ladder? What are their resources they have available and where might we start so that they can start to feel safer and have the resources available to be able to navigate triggers in a different kind of way.

So I love that book and I love the resources in that book.

Kayla: Yeah, that sounds like an amazing resource. Sarah, you have a free resource you’d like to share. Can you tell us what it is and how it can help listeners?

Sarah: Yeah, so I write a Substack called Food for Thought, and it explores the art, science and psychology of feeling safe with food.

It incorporates a lot of my knowledge that I have about intuitive eating and eating disorder recovery from a nervous system point of view. So you’re absolutely welcome to check that out and subscribe.

Kayla: Amazing. So to subscribe to Sarah Substack Food for Thought, check out substack.com/@sarahberneche

Or you can simply scroll down to the show notes and click in the link.

Sarah, thank you so much for joining us on the podcast today to share how to help clients feel safe in their bodies using somatic therapy.

Sarah: Thank you so much for having me, Kayla. It’s been great being here.

Kayla: And thank you everyone for tuning into today’s episode, and I hope you join me again soon on Your Clinical Supervisor’s Coach podcast.

Until next time, bye for now.