Current thoughts on Somatic Experiencing?
September 8, 2017 12:28 AM   Subscribe

I am interested in seeking help for mental health and life issues that I believe include depression, anxiety, ADHD, and complex PTSD. I am interested in somatic experiencing, but I'm having trouble finding detailed, unbiased information about it. I would also welcome other suggestions for treatment.

Background information:

I strongly believe I suffer from complex PTSD. This was brought up to me by a therapist I worked with several years ago, and it fits my life experiences. I also believe my symptoms match up with depression, anxiety, and ADHD, although I've been told complex PTSD may be the root cause. These conditions have been discussed with multiple mental health practicioners.

Some symptoms: I startle very easily and am visibly jumpy. I internally startle at unexpected noises, even minor, everyday ones. I believe I use many misguided self-protective strategies. I don't connect with people, even when I'm eager to get to know them due to common interests. I generally suffer from very low motivation, and sometimes even my main interests and passions don't break through. I feel that I let myself get "trapped," perhaps a form of learned helplessness: I have to remind myself that I can do what I want in a given moment, within reason, even when it comes to things like tiny adjustments to physical comfort, or switching activities during downtime. I believe that on some fundamental level, I do not trust people. I relate strongly to the idea of "emotional flashbacks" or outsized responses to triggers. I do not trust my own judgment on any issue of any shape or size, and may even unconsciously hate myself.

Other life issues: I have no social life. I have struggled with severe academic problems that intensified in high school and continued throughout my secondary education. I graduated high school with the exact minimum number of credits, which amounts to over a year of failing grades, and a GPA of less than two. After several years, I earned my associate's degree with a 2.5 GPA. I have spent much more time unemployed than most typical adults, and I do not currently have a job. I've had other life experiences that I do not currently consider traumatic, but that may have affected me, including the severe illness of a close family member when I was very young; and intense bullying, drama, and ostracization throughout primary school.

Somatic experiencing:

I have had one consultation with a somatic experiencing practicioner, and I'm not sure how to evaluate it on my own, or what to think of this method. I didn't have a strong "click" feeling with the person, but also didn't feel strongly that I should write her off. I did much of the talking, which came easily to me, but if it hadn't there would've been long silences. She shared a technique that seemed intuitive and helpful in the moment, but now I'm not sure what to think of it. It was the concept of "orienting," like a deer examining its surroundings to scan for threats.

I strongly believe I may be (or easily become) trapped in fight-flight-freeze-fawn mode, particularly flight and freeze. I am a very angry person, which often manifests as feeling internally closed-off and judgmental. I am very sensitive to displays of anger, even when I'm not the target. I am highly passive and passive-aggressive; I have very few assertive bones in my body. I am extremely sensitive to slights and criticism. I am easily scared and overwhelmed by everyday situations and encounters, and structure my life to avoid some of them. I believe I have an overwhelming need to "escape" from troubling situations, since in the past I was unable to when I needed to most. This has played out dramatically in multiple instances; one recent case was extremely beneficial and empowering, but another left me hitting "reset" after realizing I wished I'd reacted differently.

I also suffer from a lot of physical pain that I believe may have a psychological cause. I have experienced several minor but distressing complaints caused by trivial physical actions, which fade away without formal treatment. I think it's possible that I "carry" the effects of psychological trauma in my body, or that my body creates physical pain to distract me from psychological pain, or that pain results from the tension caused by anxiety. I am almost always very tired and lacking in energy, and attempts to alleviate this often don't have the desired results. I believe anxiety and hypervigilance are continuously wearing me down.

Other notes:

I am reading Feeling Good, and I think I'm already internalizing some of its messages.

I do not have health insurance. This particular therapist does not work through insurance.

I have a limited budget and will discuss payment options. I will not let a typical hourly rate stand in my way, but finances may limit some treatment options. I consider this an investment in my overall well-being, and would like to ensure it's a good one.

I will consider other therapists. I am most interested in CBT. There are reasons I am not currently interested in EMDR. Some of the other most strongly recommended treatments don't seem to be available to me.

It would be very difficult, and likely re-traumatizing, for me to mention, discuss, or privately reflect on traumatic events. I am interested in therapy that largely or completely avoids this need while still addressing related issues.


What are your thoughts on somatic experiencing? How can I best evaluate whether it would be a good fit for me? (I realize the answer may simply be "give it a chance, keep at it for as long as it seems promising, and consider stopping when it doesn't.") Do you have any other suggestions for treatment?
posted by Carouselle to Health & Fitness (5 answers total) 16 users marked this as a favorite
I am in a similar position to you in having recently started somatic experiencing treatment for trauma. I'm still unsure on it myself, but found that reading Waking the Tiger by Peter Levine (founder of somatic experiencing) at least helped me to understand how it is supposed to work. He has some youtube videos too if you'd prefer that.

I completed DBT and found it very helpful, I'm not sure if you have access to it but it certainly helps with emotional regulation. ACT therapy is something I'd look into too.
posted by Lucy_32 at 3:40 AM on September 8, 2017 [1 favorite]

Best answer: I was also going to recommend "Waking the Tiger" as well as DBT.

I've talked to one Somatic Experience therapist on a colleague/acquaintance level, and I was really impressed by what she said about how SE works and her experiences as a practitioner (I had previously read some Peter Levine, so I had some background). Her claim was that EMDR (which she had previously practiced) is great for single, discreet traumatic events, but that SE seems to work much better for complex trauma.

In my experience as a therapist, which includes a lot of work treating trauma, CBT (which is a lot of what I do) can keep people too stuck in their heads. Adding in mindfulness (which is what DBT does) or body awareness (in something like somatic experiencing) seems to create more groundedness and profound change.

I would also say that while many therapists do have training in working with complex trauma, not all of them do, and a therapist (especially a CBT therapist, I think) without that training can be a dangerous therapist for people with complex trauma. Whatever modality or therapist you choose, please make sure they have training and experience in treating complex trauma. (And there are great CBT-framework ways of treating trauma -- I'm not anti-CBT -- but I've seen naive therapists use basic CBT in bad ways with trauma clients.)
posted by lazuli at 5:52 AM on September 8, 2017 [4 favorites]

Nthing Waking the Tiger.

I am a big fan of somatic experiencing. I think if I'd found it earlier, my life would have been very different. I had been in therapy for years with many different therapists and many trials of medications, but with somatic experiencing, I was able to get off meds (I was taking three for anxiety and depression) and now don't take meds at all. In addition, my fibromyalgia symptoms went away. (To be honest, I'm having issues with that again now, but I was also diagnosed with cancer a year ago - I'm in remission now, but I'm on maintenance chemotherapy, which I think is messing me up.) Somatic experiencing as a discipline is opposed to going over traumatic experiences again and again - the theory is that it's retraumatizing, as you suggest. That's as much as I'm comfortable sharing here, but MeMail me if you have further questions, and of course, YMMV.
posted by FencingGal at 7:15 AM on September 8, 2017 [2 favorites]

DBT will help you cope but not solve the underlying problem.
After many years of mostly unsuccessful treatment the only real help I get is from learning about and daily practice of mindfulness and mindfulness meditation.
Alongside that would be a Metta practice.
Vipassana or Insight meditation - and you do not need to become a Buddhist.
This is a lifelong practice which is slowly gaining acceptance in the west.
It is opening up the world to me. Warning - it is very non-western conceptually.
Best of luck to you!
posted by Dr. Robert at 6:17 PM on September 10, 2017 [1 favorite]

DBT will help you cope but not solve the underlying problem.

It depends on how it's taught. The teaching manual is pretty explicit that participants should learn how to use the skills, then use the skills skillfully, and then trouble-shoot to make sure they're using the skills as skillfully as possible -- because the underlying assumption is that participants were never really taught the appropriate distress-tolerance, emotional regulation, and interpersonal effectiveness skills they should have been taught, so they need to fix that first -- and then, if the skills aren't actually working, recognize that maybe the problem is the other person or the situation as a whole, and move on to "problem-solving" skills. There's actually a whole set of Problem Solving skills to DBT, a lot of which are variations on "remove yourself from this situation/person." I don't know how often they're taught, but they're certainly supposed to be part of the therapy/skills.

And that progression is how most ethical therapists will work: Teach the client positive coping and relationship skills, make sure they're pretty solidly in place, and then start addressing underlying issues. Some clients come in with pretty solid coping mechanisms already in place, so that process goes quickly, but a therapist should really be invested in making sure that the treatment (especially of trauma) is not going to make things worse or dangerous in the client's life. If the client doesn't have fairly solid ways of coping with negative emotions, having them process negative emotions is not a good plan.

I've seen a lot of therapies derided as "just coping skills" but there's generally a reason they start there. They shouldn't just stop there, though I'm sure they sometime do, but I also know that a lot of clients stop there rather than continuing to do the work. And I say this also to address your concern about processing trauma -- an experienced trained trauma therapist (with any orientation) will not push you to do that until you're ready (and if you're never ready, or that takes a really long time, that's ok). They should be helping you build those skills and feeling of safety first.
posted by lazuli at 6:23 AM on September 11, 2017 [2 favorites]

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