What is somatic therapy?

by Bobbi Smith, LICSWA

More and more, somatic therapy is being integrated into therapeutic techniques.  But what is somatic therapy?  And where does it come from?  In this blog entry I will attempt to give an overview of what somatic therapy means, and how to approach a therapist about integrating somatics if you are interested.  

As always, we start with context:  all the way back in the 1600’s (yes really) there was a French philosopher named Rene Descartes who was quite taken with examining the relationship between the human mind and body.  Since his work as a philosopher was pondering things, he began to think about the process of thinking itself, which he believed took place in the mind.  He theorized that the mind and body were separate organisms, and that the mind had dominion over the body.  This theory was known as Cartesian dualism, or sometimes mind-body dualism.  

Though there were always people that opposed Cartesian dualism, when what we now know as Western medicine began to form and institutionalize, it carried the legacy of Cartesian dualism with it.  Treatment of bodily ailments and treatment of mind ailments developed as distinct disciplines.  We don’t know if this is what Descartes intended, and can’t say for sure how he would react if he were alive to comment on it, but it unfolded this way anyway.

For generations, psychology has had the task of treating what western medicine firmly categorized as ailments that are located within the container of the mind, and therefore should be treated in that location, using the vehicle of thoughts to transfer a cure from the psychologist to the patient.  The most famous of these is “the talking cure” developed by Sigmund Freud.  In this approach, the psychologist would aggressively analyze the patients every word, which is 1. Deeply unethical and 2. Super annoying.

I’m getting to the somatic stuff, I promise.  

Let’s jump forward.  For decades now, some doctors, therapists and clients have questioned the utility of Cartesian dualism to truly address the complexity of mental and physical health conditions, and have been developing treatments that integrate both mind and body.  Soma means body.  Somatic therapy means incorporating some dimension of work with the body into treatment for ailments that used to be considered to be solely of the mind:  depression, anxiety, post traumatic stress disorder, and more.  

There are many traditions of what is called collectively somatic therapy- Sensorimotor Therapy, Somatic Attachment Therapy, Somatic Internal Family Systems, and more. There is no singular type that is agreed upon as the best approach.  Therapists that integrate somatic therapy into their practices are trained in and draw inspiration from traditions designed by many different healers, and that is a good thing.  Just like every other type of therapy, there is no one size fits all.  In addition, there are many, many traditional healing methods practiced across the world that include some type of body work, to which western somatic therapy traditions owe great honor.

The tradition I myself am mainly trained in is called Somatic Experiencing- I am not certified but simply studying it.  Somatic Experiencing was developed to treat PTSD, or what is now mostly called simply trauma.  The thesis behind Somatic Experiencing is that trauma can cause wear and tear on the autonomic nervous system, and so, trauma treatment should include the autonomic nervous system.  The autonomic nervous system is a component of the peripheral nervous system that regulates involuntary physiologic processes including heart rate, blood pressure, respiration, digestion, and sexual arousal. It contains three anatomically distinct divisions: sympathetic, parasympathetic, and enteric.  The autonomic nervous system lets us be relaxed, spontaneous, and socially engaged in a safe environment, or prepares us to fight, flee, or freeze in response to a threatening one.

Our human brains have evolved with add-ons to other species' brains, but we didn’t lose anything from them.  Basically, we have new apps but not a very different operating system.  As such, we have instincts to respond to harm or perceived harm in ways similar to other species.  Somatic Experiencing considers humans, aka homo sapiens, part of an evolutionary lineage that shares bodily features (such as an autonomic nervous system) and bodily instincts (such as fight, flight, or freeze) in common with other animal species that are evolutionarily older than us, and honors the innate intelligence of those similarities. In a threatening situation, animals either run to get away, fight off the threat, or if those don’t work, play dead (freeze) to appear unappetizing to a predator until it wanders away.

As animals, if an instinctual survival response sets off an alarm in our autonomic nervous system telling us to fight, flee, or freeze, it is important that that protective response is allowed to fully play out in service of its goal:  to get to safety.  If that response is prevented or constricted, the unresolved instinct can remain trapped in the nervous system as a chronic trauma response, or PTSD.  That can mean someone can feel trapped by the instinct to constantly fight, flee, or freeze, even if they aren’t in an unsafe situation anymore.  That is because even though our mind can cognitively register when a threatening situation is no longer happening, at the level of the organism (or body) there is no real proof of that, because all the nervous system knows is that it couldn’t do what it needed to in order to protect itself.  The nervous system doesn’t know time.

If that response were allowed to play out to its natural conclusion, our nervous system settles back into its baseline state, which is a proper flow in real time and proportional to what’s currently happening around us- not stuck in a chronic response.  We'll start in therapy by creating a safe container, building skills to cope with overwhelming emotions, thoughts, or body sensations. Then, when you're feeling ready, we may slowly approach your traumatic narrative, attending to body sensations along the way and supporting the discharge of trapped fight/flight/freeze energy.

One thing I love about Somatic Experiencing, and all types of somatic therapy, is that they acknowledge that human beings have evolved capacity for abstract thought, but otherwise are not fundamentally different from other animals per se.  Somatic therapy acknowledges the intelligence and healing instincts of other parts of our bodies besides just our minds.  Our bodies have instinctive reactions to what’s going on around us- and that means involving the body in therapy can have profound positive impacts on our sense of not only ourselves, but the world.  And who wouldn’t benefit from more wholeness and integration?

Most of our therapists at Riverbank incorporate somatic traditions into their treatment approaches. If you’d like to schedule a free 20 minute consultation with one of our therapists in-person in Seattle, or online for residents of Washington state, click here to fill out our contact form!

Your Nervous System and the Window of Tolerance

The nervous system is composed of the brain, spinal cord, and nerves that go throughout the body. The nervous system is the command center of the body, responsible for our thoughts, movements, and automatic processes such as breathing and digestion. Importantly, the nervous system is also responsible for our experience of emotion. Understanding your nervous system can help you become more aware of your emotions and how you can manage them without becoming overwhelmed.

Let’s start with a brief overview of the brain using this handy model created by Dr. Dan Siegel and based on the triune brain model by Paul McLean. It can be helpful to familiarize yourself with three major parts of the brain: (1) the brainstem (responsible for basic survival functions like breathing and heart rate); (2) the limbic system (the emotional center of the brain, responsible for our fight/flight/freeze response) and (3) the cortex (the “thinking and reasoning” part of our brain, responsible for managing big emotions, connecting with others, and helping us make thoughtful decisions).

(Image from Kerra-Lee Wescombe, 2021)

When all three parts of the brain are working together, we feel safe and connected to others. This is the optimal zone of nervous system arousal, known as our window of tolerance, or our social engagement system.

Window of Tolerance

Window of Tolerance, a term coined by Dr. Siegel, refers to the zone of nervous system arousal in which we are able to function and engage with other people most effectively. In this zone, our brain can process stimuli without becoming overwhelmed. This means the thinking part of our brain, the cortex, is online and helping us keep our nervous system (and emotions) regulated. This state is associated with our parasympathetic nervous system and is also known as the “rest and digest” state.

(Image adapted from NICABM, 2019)

When we are within our window of tolerance and difficulties arise in our day, we are able to handle them without our nervous system becoming dysregulated. This means that we can manage our emotions without getting overwhelmed.

Within this zone, we feel safe and socially connected. We are grounded, open, curious, flexible, and able to take on challenges. We feel calm but not exhausted, energized but not anxious. When emotions like frustration or sadness take us closer to the edge of our window, our thinking brain is able to use strategies to keep our nervous system regulated so we can stay within our window. This diagram shows how our nervous system ebbs and flows when we are within our window and our brain is able to regulate our emotions:

          (Image adapted from Levine, Ogden, Siegel)

 Sometimes, however, we can get thrown out of our window of tolerance when our limbic system sends our thinking brain offline. This happens when it senses danger and sends our nervous system into an automatic fight, flight, freeze, or collapse response. This state is associated with our sympathetic nervous system.

Fight/Flight/Freeze/Collapse

Our limbic system contains the part of our brain responsible for sensing threat and protecting us from danger. It can make split-second decisions to keep us safe, whereas our thinking brain wouldn’t be able to respond as efficiently to danger. Therefore, when our limbic system senses danger, it can turn our thinking brain offline and trigger our fight/flight/freeze/collapse response, moving us outside our window of tolerance in its attempt to keep us safe.

When we are in this state, our nervous system is over-activated, or hyperaroused. Our body is alert and ready to fight or flee danger—or it may freeze to avoid danger. Our breathing and heart rate quicken, our hearing becomes sharper, our skin sweats, our muscles tense, and our pupils dilate. Here we can feel anxious, panicked, angry, or out of control.

In the collapse response, on the other hand, our nervous system is under-activated, or hypoaroused. Our heart rate drops, our breathing slows (we may even hold our breath), and we feel immobilized. It can be easy to confuse the freeze and collapse responses, so it may be helpful to imagine you are playing a high stakes game of hide and seek. The seeker is right outside your hiding place. You are tense, alert, hyperaroused because you know they might find you: this is freeze. Suddenly, they lock eyes with you, and you’re defeated, hopelessness: this is collapse. In collapse, we can experience exhaustion, numbness, dissociation, depression, shame, and hopelessness.

(Image from Mind My Peelings, 2019)

The fight/flight/freeze response evolved over ages to keep you safe and alive. It was very useful in our early hunting and gathering days when we encountered regular threats to our survival, like dangerous wild animals. And it is still useful when you are faced with real threats to your safety, like when you have to slam on your brakes to avoid hitting the car in front of you. In this case, you want to be dysregulated so you can respond effectively: You don't want to be in your window all the time.

However, our fight/flight/ freeze response is also frequently triggered by non-life-threatening occurrences, like a first date, a bad grade, a deadline, an argument, or a visit from your in-laws. While these are stressful events that can result in ebbs and flows in your nervous system and move you toward the edges of your window, sometimes our nervous system responds as if these events are life-threatening, sending us outside our window into fight/flight/freeze.

Why do I react so strongly to stress?  Your window of tolerance can narrow and widen based on a number of factors, even throughout the day. If you have experienced trauma or you are going through a stressful time, your window can become very narrow. When your window is narrow, your nervous system is even more attuned to potential dangers, triggering your fight/flight/freeze response more often and for even smaller “threats.” This means your limbic system may sense danger when there is none. Unfortunately, by trying so hard to protect you, your limbic system is unintentionally sending your nervous system on a roller coaster ride that can keep you from experiencing safety and connection.

Expanding your window

How can you expand your window of tolerance? An important step in expanding your window is getting to know your nervous system a little better (you’re already doing this!) and starting to notice what it feels like both when you are within your window and when you are outside your window. You can start to notice what your body feels like when you are calm and connected—and what your body feels like when your emotions are dysregulated. You can start to take note of the types of triggers and situations that your limbic system labels as dangerous.

An equally important step is taking care of your body’s most basic needs like sleep, healthy food, and exercise. Even factors like feeling tired or hungry can narrow your window. Do you tend to snap at others more easily when you’re hungry for dinner? That’s because when your body is running low on something it needs for survival, your window can shrink. Anything that puts your body on high alert-–like physical or emotional pain, perfectionism, self-criticism, and disconnection-–can be a force that narrows your window.

Learning strategies for managing stress and finding ways to connect with other people are also ways to expand your window. Additionally, mindfulness and self-compassion are practices that can make your window bigger over time. Working with a mental health professional to process trauma and difficulties can also help you expand your window and get back to feeling safe and connected.

Coming back into your window

How can you come back into your window once you’ve gone outside? When your limbic system has sent your thinking brain offline and you are outside of your window of tolerance, there are many things you can do. As a general rule of thumb, if you are in fight/flight/freeze mode (hyperarousal), you may need to release energy and then sooth. If you are in collapse mode (hypoarousal), you may need to add energy to your system.

To release energy and then decrease arousal from fight/flight/freeze: First, you might try releasing the energy. Dance, go for a walk, run up and down the stairs, shake your body all around. Then, find something soothing. This might include: deep belly breathing (with exhales longer than inhales), laying on the ground, using a weighted blanket, drinking tea, listening to soothing music, making comforting food, stretching your body, giving yourself a hug, meditating, practicing yoga, or engaging in the 5-4-3-2-1 grounding exercise (find 5 things you see, 4 things you can touch, 3 things you can hear, 2 things you can smell, and 1 thing you can taste).

To increase arousal from collapse: Try out some physical activity like dancing, walking, or even just simply sitting up straight or standing and feeling your feet on the ground. You can also try listening to energizing music, rubbing your arms and legs, or stomping your feet on the ground.

Additional ways to regulate include taking a cold shower or dunking your face in ice water, journaling, doing something creative like drawing or playing an instrument, and increasing your emotional vocabulary (get out that emotion wheel and put a name to what you are feeling!).

Co-Regulation: All of the above tools are focused on what we call self-regulation (tools that you can use on your own). However, co-regulation (tools that are used with others) can be just as important for coming back into your window (as well as widening it). This might look like asking for a hug, petting your dog or your cat, or calling a friend. The people in our lives we feel safe with are one of our greatest resources when it comes to reducing stress, so reaching out for support is a great way to come back into your window of tolerance.

Therapy: If you’d like to explore these topics more specifically, and with a therapist trained to bring the nervous system into trauma therapy, we have therapists with openings for new clients in Seattle who are offering both in-person and virtual sessions. Click here to schedule a free 20-minute consultation now.

Sources:

https://kiddomag.com.au/education/a-handy-way-of-looking-at-childrens-behaviour/

https://www.goodtherapy.org/blog/psychpedia/window-of-tolerance

https://www.mindmypeelings.com/blog/window-of-tolerance

10 Ways to Connect with Yourself

by Abby Lombardo, LMFT

1.     Write a “Where I’m From” poem.

What it is: The Where I’m From poems are part of the I Am From Project (for examples and more information: https://iamfromproject.com/poems-thru-8-2020/) connecting people to themselves and to each other through our personal stories and backgrounds. It is a type of prompted poem that incorporates aspect of your history, background, family, location, identities, memories, and feelings of your beginnings.

Why it works: Often times, we forget that stories are deeply connecting and help us make sense of our own existence. Humans are storytellers, brains respond well to stories. They give us a framework for our experiences and for things we do and do not quite understand. Working on a “Where I’m From” poem could help you connect to aspects of you that have gone unexamined, but that remain an integral part of who you are and how you see the world today.

2.     Create rituals and routines.

What it is: Just like stories, most brains and bodies respond well to rituals and routines. Maybe it is a morning routine, a way to make space for time that does not belong to anyone else or your job or your never-ending to-do list. Maybe it is an after-work routine, a way to unwind your body and mind. Maybe it is a bed time routine, a way to cue your mind when it is time to rest and get sleepy. Whatever and whenever it may be, a ritual or routine can be a great way to connect with yourself better.

Why it works: I once heard: wherever we spend time, we invest it. Wherever we give our time, one of our most valuable and limited resources, is where we are investing ourselves. Rituals and routines are powerful placeholders in our fast- and faster- paced lives because they cause us to invest time in what sustains us, give us moments of pause and intention, and create structure around what we truly value and need.

3.     Move.

What it is: When I use the term movement, I use it very intentionally. I’m purposefully not using the world “exercise”, though that does fall under the umbrella of “movement”. Movement is anything from neck and shoulder rolls, to yoga, to Pilates, to stretching, to shaking, to dancing and all and everything else that you can do with your body!

Why it works: Finding joyful movement, moves that feel good, create feel good feelings, etc. is one of the body’s natural ways to process emotional energy and boost mood! Some movement is challenging and sweat-inducing, some movement is calm and relaxing, whatever your body needs and wants go for it! Remember to have fun with it, stay within your body’s limitations, and that you do not have to move if you do not want to!

4.     Use your breath.

What it is: Your breath is most often the most accessible way to connect with yourself—it’s always there. Connecting to yourself through your breath can happen many different ways:

• simply noticing your breath as it is with no changes (the speed, depth, quality, sound, sensation, movement of body parts, temperature of the air, etc.)

• deepening your inhales and exhales (counting can help you slow down your breathing and keep your mind busy)

• adding a pause at the top or bottom of your breath (stopping when you’re full of air and stopping when your lungs are completely emptied. *not fully recommended for those who experience panic attacks or are triggered by holding their breaths.

Why it works: Your breath can tell you a lot about your current state of being. Is your system under stress? Are you scared…relaxed? Breathing is also a powerful tool in changing your current state of being. While breathing changes in response to your brain and body reacting to the environment or situation, it can also work in reverse – something called bidirectionality. Breathing signals your body and brain how to respond to the environment, too! By intentionally noticing and then deepening your breath, you are increasing awareness of your body’s response and are giving it a chance to change that response.

5.     Start a “Body Letters Series”.

What it is: When I was working in a higher-level of care eating disorder treatment center, we would have daily therapeutic groups for clients to learn (and unlearn) some things about their relationship to themselves along their recovery journey. One of the most powerful prompts we ever used around connecting people to their bodies is called “The Body Letters Series”. The prompt is this: write a letter to your Body. Then, have your Body write back. You can keep it going as long as you’d like, back and forth, back and forth.

Why it works: In dominant American culture, we are not taught to relate to our body as a being, instead it is a thing, object, project, toy, etc. When we change the way we relate to our body, we create so much more room for change within the relationship. And relationships include all types of feelings and thoughts: love, hate, ambivalence, grief… When we realize that our body has something to say, some wisdom to share with us, we are fundamentally changing how we relate to ourselves. The truth is our bodies have an ancient type of knowledge, one of instinct and intuition, of the intangible. This means that our bodies do not often speak in words, but in images, feelings, sensations, memories, pain, colors, temperature, movements, etc. Body Letters can be a start to allowing your Body the room to speak. Since words might be limited, then you might tweak the prompt and instead of writing a letter—you sit still and ask your body what it has to share with you. The more we do this, the better we can connect to this ancient somatic wisdom that is always with us, always a part of us.

6.     Validate yourself.

What it is: I’ve come across clients who were never given validation for their internal experience, who then never learned how to give themselves the validation they so desperately sought, that we all need. This is when I learned the importance of validation and the power of giving it to yourself.

How to validate: 1) acknowledge emotion/sensation/feeling/thought/whatever is part of your experience, 2) name or identify this experience (if you can, if not stay with it and go to next step) 3) say to yourself one or some of these phrases (or something like it):

• “It makes sense that I am experiencing this (because…)”

• “Wow, I’m having a hard time struggling with this.”

• “This is hard.”/ This is scary. / This is overwhelming./ This is ____.”

• “I’m experiencing a lot right now.”

Why it works: This 3-step validation process encourages us to acknowledge and accept our experience without trying to change it or berate ourselves for feeling it. This process allows space for self-compassion and self-kindness in the form of simple acceptance: This is what I’m feeling. This is ____. From here, we have more room to respond how we want to: with kindness, with comfort, with rest, with asking for help, etc. When we learn how to validate our own experience, we can become less desperate for others to meet that need for us and we get better at meeting it ourselves.

7.     Keep small promises to yourself & offer yourself what you need.

What it is: Connecting with yourself through keeping small promises or giving yourself what you need follows nicely after self-validation mentioned in #6. Keeping small promises to yourself builds self-trust. For example, maybe you know already that planning your meals helps you eat more consistently, then keeping the promise to meal plan is a way to take care of yourself and offer yourself what you need. Maybe you know that after you journal, you feel a release of emotion and you feel better, then keeping the promise to journal builds trust that you will do what you need when you need it. The possibilities are endless: going to bed at the time you set for yourself, giving yourself time to read or space out during your day, drinking enough water, it really doesn’t matter what it is as long as it is something you can reasonably offer yourself without getting caught up in the self-shame spiral of “I didn’t do it today”. Self-trust is also forgiving yourself and doing your best at the next opportunity.

Why it works: Your body, your psyche needs to know that you will listen and respond to its needs as they come to your attention. A lot of times we are not paying attention to our needs, physical or emotional or otherwise! Once we cultivate the awareness, we have the responsibility to ourselves to act in a way to meet these needs. If we don’t, bad things usually follow: somatic symptoms, pain, anxiety, depression, restlessness, illness, etc. etc. Needs can be small: drinking water, 3 meals a day, 20 minute naps or they can be abstract needs: purpose, direction, hope. The more practice we get at listening and following through with what we need, the more we connect to ourselves and the better we move through this world.

8.     Create a “Body Poem”.

What it is: Much like Body Letters, Body Poems are something I discovered in my own healing journey that allowed me to better connect to my body from a more body neutral capacity. Body Poems are poems, prose, or writings about each body part and what that body part has endured or how it functions to support you as a human being.

Why it works: Body Neutrality, the idea that we can relate to our bodies not for how they look or their shape or size but for what they can do, how they function, and how they support daily life. Body neutrality offers a different way to connect with ourselves, our bodies, that lies outside of the “you must love yourself and you are beautiful all the time and you should feel beautiful all the time because you are just the way you are” extreme body positivity culture. For some, that standard is just too far away and it creates shame and guilt in others. Body positivity is amazing! For some of us, body neutrality is also an amazing, hard-earned place to be at with ourselves. Body Poems allow us to really spend time with the separate parts of our bodies, diving into what they hold for us (memories, pain…) and what they do for us (breathe, lift, move, beat, embrace, rest, dance…).

9.     Try something new!

What it is: Could be anything! Try a new hobby, creative pursuit, a new outfit, a new game, a new skill, a new genre of book!

Why it works: Trying something new is a great way to discover parts of yourself you’ve not interacted with. When we face novel situations, we learn a lot about ourselves. We learn that we’re actually rather hard on ourselves and like to be too perfectionistic. We learn that we’re actually rather suited to embroidery or rock climbing. We learn how we fare through new challenges, hopefully earning a new sense of pride and confidence or learning to be okay with not being the best at everything.

10.  Go to therapy! :)

What it is: weekly, biweekly, monthly, etc. sessions with a mental health professional where you can work on challenges, practice new responses, create new insights, and acknowledge past dynamics. It’s a space to be heard, seen, understood, validated, and challenged.

Why it works: It’s the magic of therapy. It’s the deep healing that happens within a therapeutic relationship between two people willing to show up and see what happens. Therapy can be what you make it, and you only get out what you put in. Therapy is an excellent tool for connecting better with yourself and with others. If you’re thinking this might be the time for you to start therapy, click here to inquire about our team’s availability!

***Disclaimer: Some of these 10 ideas for connecting with yourself could connect you to some deep pain or trauma in working with your body or self in a new way. If this is the case, please stop or take it slow, know that you do not have to do this alone, and seek out help from a professional.

Connecting to Your Body

"How do you know what your body needs?? Sorry if that is a silly question."

I got asked this question recently, and needed to share that…This is not a silly question AT ALL. We are brought up to disconnect from our bodies. We are trained to ignore, silence or control our body's needs. Of course it's difficult to know what your body needs and how to give her that.

You're told to clear your plate, even though you're full.

You're told to dress a certain way, because your shoulders are "distracting" to the boys at school.

You're told to raise your hand in order to go oee.

You're told to stop crying.

You're told to sit still and be quiet, when you want to talk and move.

That's almost all of us. On top of that, you may have experienced trauma as a child and/or as an adult, and trauma-related survival reactions often lead to dissociation and disconnection from the body, furthering the disconnect.

I say all of this to remind you that connecting to your body can be extraordinarily difficult, and at times painful. We live in a society and many of us grew up in a family that does not value the information coming from your body, and sees her as another object to control and overcome. It's hard to listen for the needs of your body when you've been taught to ignore, silence or control them.

The process of reconnection is unlearning this training, and relearning how to be in connection with your whole self.

Questions to reconnect with your body's needs:

1) consistently (like, several times a day) ask yourself: "what am I feeling right now?" Look for emotions and body sensations.

—name what emotion(s) you're feeling. Check in with each part of your body (or start with one part if that feels more doable and safer): what sensations are in your feet? Legs? Low back? Chest? Upper back? Face? Check out this body sensations list. Name those sensations, which will help you connect emotional states to how they show up as sensation in your body, and will help lead to you what your body might need in that moment.

2) consistently (like, several times a day), as yourself: "what do I need right now?" Base your answers off of things like comfort, relieving pain, exploring stillness vs movement.

—Are you cold? grab a blanket and see what happens.

—Do you notice dryness in your mouth, or a grumbling in your belly? drink some water and/or eat a snack and notice how that changes things.

—Do you have some tension in your upper back? Get up and stretch or move a bit, and notice how that shifts the tension.

Take an experimental, curious attitude. Rather than "this sensation is horrible and uncomfortable", just notice "hmm, there's some tension in my shoulders, I wonder what happens if I move my arms around or change my posture."

Just noting the emotion, body sensations, and various actions that might shift your experience is part of how you begin to hone in on what your body needs and respond to those needs more consistently.

This takes time and practice. Please be patient and kind with yourself.

Your Guide to Starting Therapy

by Abby Lombardo, LMFT

It’s daunting.

I get it.

Yes, I, too, have had to search for a therapist (therapists seeing therapists who see therapists, it’s a thing) and have just stared blankly at my screen hoping the right someone would fall into my inbox.

In this way, searching for a therapist is like dating: you’re basically courting someone to see if they are trustworthy and make you feel comfortable enough to tell all of your vulnerabilities and still feel accepted by them.

 Actually, it’s a lot like dating.

 It’s also like searching for an apartment or a place to live, you might not know it’s a good fit until you try it out, step into the space, spend some time there…to know if it is a good fit or not for what you’re needing.

That’s the important part: try to focus on what YOUR needs are at THIS time in your life and the kind of person/professional you’re looking to help support your journey.

To aid in this purpose, I’ve devised a “Searching for a Therapist Cheat Sheet” that outlines common words, phrases, acronyms, and questions to help guide your search. It can help to feel informed and oriented to the search process, so that you can focus more on what the professional has to offer YOU.

Ideally, this information is best used in a consult with a provider. A consult is usually a free 15-30 minute meeting (over the phone or virtual) to assess whether you’d like to work together and schedule your first appointment. If the provider’s website or profile page doesn’t advertise that they do consults, don’t be afraid to ask!

Let’s get started with common therapy words used in the search for a therapist, that might not be so intuitive or self-explanatory.

7 Common Therapy Search Words:

1.      Specialty: this is something a professional has added training, experience, and interest in. Usually this includes some kind of certificate, training, and additional letters after their name. It is also probably the clients they have seen and want to see. Pay attention to these, they can be a helpful way to filter through who you might want to work with on a certain issue or topic.

2.      Modality: this is a bit different than specialty in that it refers to the way a therapist conducts treatment, or, how they do therapy. Modalities are therapeutic frameworks, lenses, theories that often guide the professional’s way of doing things in session. See more in the Acronyms section for the names of several common modalities to know about.

*The cool thing? Research shows that it’s not necessarily the modality that brings success in therapy, but the relationship you have with your therapist! So, modality does not make or break unless it leads to you not vibing with your therapist!

3.      Intake: the term for the 1st session. Intake sessions are usually billed at a higher rate than normal sessions as they are used traditionally for assessment, onboarding, orientation, and paperwork. Intake sessions vary from therapist to therapist. Some have you, the client, talk about why you’re coming to therapy and what the issues are you’re experiencing. Some will ask for your family information to get more context. Some will go through a timeline with you of different experiences you had while growing up. Mostly though, they’ll all discuss confidentiality and privacy with you, as well as the exceptions and you will probably be asked about why you’re coming to therapy, what your goals are, and how the therapist can support you.

4.      Scope of practice: this is a lot like specialty and modality in that it is WHAT a professional provider can OFFER you in terms of services. For example, a marriage and family therapist (LMFT) cannot prescribe medications, it is legally and ethically outside of their scope of practice. Make sure you are looking for a provider who can offer you the services you are actually looking for.

5.      Somatic-focused: this term refers to anything body-related. Somatic techniques and modalities often help you learn to work with and regulate the systems of the body: the “flight, fight, freeze” system and the calm/rest/soothe system (for example). A somatic-focused therapist might ask you: “Where do you feel that in your body; can you describe it?” If this feels daunting, they are there to help you every step of the way. They see the body as a source of wisdom and connection. They also see the body as the #1 place that we store all of our emotion, trauma, energy, and pain. There’s a lot you can work with somatically that you might not be able to through talking.

6.      Attachment-based: this refers to a general modality/theory of therapy that examines and explores the way you relate to people and things. Attachment begins when we are infants, depending on caregivers to provide us with what we need to sustain life and be nourished. How we attach/ed to our caregivers can have a lot of sway over how we relate to significant others and even friends. This modality is incredibly informational and slightly Freudian, and most therapists have training in this, though some zoom in and use only an attachment-based lens as their main modality or get extra training in it.

7.      Mindfulness-based: this refers to a therapist who uses present-focused, attention-centering techniques in the therapy session or for the client’s homework to engage the client more mindfully with the here and now, whether that be with your breath or with the uncomfortable, restless feeling you are having. Mindfulness has many, many amazing benefits and can really help with anxiety, mood, and attention issues.

9 Common Therapy Acronyms (in alphabetical order!):

1.      ACT: Acceptance and Commitment Therapy – teaches mindfulness-based coping tools for unwanted/negative thoughts and emotions, while focusing on identifying client’s values and moving towards goals based in the client’s values.

2.      CBT: Cognitive-Behavioral Therapy - probably the most common therapy acronym used these days; explores the connections of the 3 parts of the CBT Triangle: thoughts, emotions, behaviors and how they all interact with each other to build negative cycles and habits. Offers ways to interrupt negative/unwanted thought, emotion, or behavior sequences through practical changes and reframing. Most mental health professionals are trained in this type of therapy.

3.      CPT: Cognitive Processing Therapy – a common therapy for treating PTSD

4.      DBT: Dialectical Behavioral Therapy – a skills-based therapy that offers tools for many things including: self efficacy/assertion, emotion regulation, distress tolerance, receiving feedback, making a decision, etc. Great for someone who benefits from structured therapies.

5.      EFT: Emotionally-Focused Therapy – often for couples, this process-oriented therapy strives to find the vulnerable, intimate spots that we often try to protect out of fear or hurt and uses it to reconnect partners who are struggling.

6.      EMDR: Eye-Movement Desensitization and Reprocessing – this therapy is very cool. It is a somatic-based, trauma therapy that uses your body’s way of processing information to help you work through issues, sometimes without talking about them with the therapist. They teach a lot of coping strategies so that you feel ready for what comes up, too. Essentially, they use what you naturally do in REM sleep in session and utilize bilateral stimulation (sensation happening on 2 different sides of your body at different intervals). This is a therapy that I recommend for people who want to have tools and process their trauma without having to re-hash a timeline or go detail by detail with a therapist – or for someone who talk therapy just hasn’t helped much.

7.      IFS: Internal Family Systems – a family systems therapy that is also used with individuals in therapy to look at the different “parts” we all have within us that make us who we are and influence our behavior. For example, most clients have a “part of them” that wants change and a “part of them” that resists or is scared of change. IFS therapists work with these different parts in different ways to work towards client’s goals and self-integration.

8.      RO-DBT: Radically-Open Dialectical Behavior Therapy - this is a specialized therapy, that is derived from traditional DBT but geared more towards those that are over-controlled, think: perfectionist, Type-A people. This has been used successfully with those with eating disorders as well. RO-DBT is also a skills-based, structured therapy that teaches skills about emotional expression, social signaling, self-inquiry, personal effectiveness, boundaries, how to receive feedback, how to challenge rigidity in order to be more flexible, etc.

9.      SFBT: Solution-focused Brief Therapy – a strengths-based, post-modern approach that believes the client is the expert in the therapy room and the therapist is the guide to the client’s own wisdom about what has worked for them and what they want instead of the issues/problems they are experiencing now. Together, they build moments of “exceptions” to the problem and identify what success and solutions looks like for the client, sometimes without diving too deeply into the problem. “Brief” refers to length of treatment common for this type of therapy (~ less than 10 sessions, but not all SFBT providers limit their sessions to be this brief).

10.  TF-CBT: Trauma-focused Cognitive-Behavioral Therapy - this framework is therapy that guides the clinician and the client through trauma processing. Usually the therapy involves desensitizing oneself to one’s trauma story by sharing it with the clinician and reframing and reprocessing where necessary to work through an “old trauma story” and hopefully find a new story that helps the client integrate the events into their life while decreasing triggers and PTSD symptoms.

Questions to Ask Them (at first contact/consult):

1.      Do you take insurance/how much will this cost?

2.      What would a session with you look like?

3.      What experience do you have working with these issues/topics?

4.      How frequently will we meet/What determines the frequency of sessions?

5.      What are your specialties?

6.      What modalities do you use?

7.      What client do you work with best?

Questions to Ask Yourself (after first contact/consult):

1.      Did I feel comfortable talking to this person?

2.      Do I feel hopeful about working together?

3.      Did I feel heard and understood?

4.      Does it feel like a good fit for what I’m needing/wanting right now?

5.      Am I looking forward to my next session?

I hope you can use this cheat sheet to feel empowered in your search to find the a provider who is a good fit for what you are needing.

Trust yourself.

And if it turns out to not be such a good fit, you have the right to terminate treatment at any time! Remember, research shows it is the quality of the therapeutic relationship that determines overall therapeutic success.

Good luck out there! I’m cheering for you!

If you’re interested in scheduling a free consultation with one of Riverbank’s therapists, fill out the contact form here.