Talk Therapy vs Somatic or Psychosomatic Therapy: What’s the Difference?

I often get asked about the difference between talk therapy and somatic or psychosomatic therapy, and I like to explain it through a simple analogy.

Imagine walking into a dark room. The first thing you do is switch on the light.

Suddenly you can see what’s there. Maybe there are dirty dishes in the sink, the bed is undone or the room needs some attention. None of this appeared when you switched on the light. It was already there, but now you can see it.

This is a little bit like what happens when we begin looking at our own story.

In talk therapy, you tell that story. You go through the episodes and experiences of your life, including the beliefs you formed, the adaptations from early childhood and perhaps trauma you experienced along the way. Through talking and reflecting, you can begin to recognise patterns and understand why you may respond to certain situations in a particular way.

The light is on and there is awareness of what is in the room.

But awareness and change are not necessarily the same thing.

When we bring the body into the conversation

In somatic or psychosomatic therapy, we take the same story and become curious about how it is reflected in the body.

While you’re talking about something that happened years ago, your chest might suddenly become tight or you may notice discomfort in your stomach. Perhaps there is tension, sadness or anxiety that seems to appear almost immediately. At other times, the strongest reaction isn't an obvious physical sensation at all. The mind becomes busy, judgmental or determined to explain what is happening.

Rather than moving quickly past those reactions, we give them some attention.

This is where mindfulness becomes an important part of the work for me. We are not using the breath or another technique to make an uncomfortable feeling disappear. Instead, we allow ourselves to notice what is happening without immediately deciding that it needs to change.

There is a softness in approaching ourselves this way. Instead of asking, How do I get rid of this?, we can become interested in why it is here.

When we understand the story, but something still reacts

We can have a very clear intellectual understanding of ourselves and still find that certain situations create an immediate reaction.

You may have already made sense of an experience from childhood and recognise that the belief you formed then no longer reflects your life today. Yet something happens and, before you've had time to think about it, your body responds.

This is one of the places where somatic work becomes particularly interesting to me.

The reaction isn't necessarily evidence that something is wrong or that all the previous work has failed. It may be an old adaptation that once made complete sense. Perhaps it helped us maintain connection, protect ourselves or cope with something we didn't have the capacity to process at the time.

Compassionate Inquiry has greatly influenced how I understand this. Rather than only asking what happened, we can explore what we came to believe because of what happened and how that belief may still be shaping our experience today.

There is also something here that connects with Byron Katie's work. We can believe a thought for so long that eventually we stop recognising it as a thought. It becomes part of the way we see ourselves and the world.

A belief such as I'm not safe or I'm not enough doesn't necessarily appear in our mind as a neat sentence. Sometimes we recognise it indirectly through the way we respond to situations, the choices we make or what begins happening in our body when something touches that old place.

This is why I don't see the mind and body as two separate parts of therapy. Our thoughts, memories, emotions and physical responses are part of the same human experience, and sometimes understanding that experience requires more than talking about what happened.

If the issue is embedded in the tissue

I often use the phrase “if the issue is embedded in your tissue, we have to include the body in the conversation.”

Peter Levine's work has been particularly influential in bringing attention to the body's role in trauma and what happens physiologically when we experience something overwhelming.

But somatic therapy isn't about searching through the body trying to find trauma or forcing ourselves into an emotional experience because we believe something needs to come out.

Quite the opposite.

It can be a very gentle process of noticing what is already happening and giving it enough space to be experienced without immediately judging, analysing or trying to change it.

Perhaps there is a sensation that appears when you talk about something difficult. Perhaps your breathing changes or your body suddenly becomes tense. Sometimes an emotion arrives before there is even a clear explanation for why it is there.

The invitation is to become curious about that experience.

What does this actually look like in a session?

This is probably where the difference becomes easiest to understand.

We may be talking about something that happened in your childhood, a relationship or a situation you're experiencing now. While you're telling me the story, I might notice a change and ask:

What happens in your body when you say those words?

Has anything changed in your body just now?

Is there a sensation somewhere that you can notice?

And sometimes I may ask, Where did you go just then?

By that I don't mean physically. I might notice that you suddenly became very quiet, disconnected from what you were saying or perhaps moved away from what you seemed to be feeling. The question is an invitation to notice what happened internally in that moment. Did a thought appear? Did something change in the body? Did you suddenly feel the need to move away from the experience?

These aren't questions with a correct answer, and sometimes the answer may simply be, I don't know.

That is also information.

The purpose isn't to produce a dramatic emotional release or discover another hidden trauma. It is to become more aware of our experience as it is actually happening, rather than only looking back and explaining it afterwards.

For me, this is where mindfulness, somatic work and Compassionate Inquiry naturally meet. There is an opportunity to stay close to our experience with curiosity and compassion, while also questioning some of the beliefs and stories we have carried with us for years.

Sometimes switching on the light is an enormous part of the work.

And sometimes, once the light is on, we need to spend a little time in the room.

Books that are fundamental to my work

Gabor Maté — The Myth of Normal A powerful exploration of trauma, adaptation, health and the relationship between our individual experiences and the culture in which we live.

Peter A. Levine — Waking the Tiger: Healing Trauma One of the foundational books on understanding trauma through the body and our physiological responses to overwhelming experiences.

Byron Katie — Loving What Is An introduction to questioning the thoughts and beliefs that shape the way we experience ourselves, other people and our lives.

Tara Brach — Radical Acceptance A beautiful exploration of mindfulness, compassion and learning to meet our experience without constantly being at war with ourselves.

Jack Kornfield — A Path with Heart A deeply human exploration of mindfulness, compassion and bringing spiritual practice into the reality of everyday life.

Michael Brown — The Presence Process An exploration of emotional integration and present-moment awareness, with a particular focus on learning to meet uncomfortable emotional experiences rather than automatically reacting to or trying to escape them.