Somatic Experiencing Clinical Protocols: Session Structure, Techniques, and the Art of Tracking the Nervous System

Category: Somatic Therapy / SE | Level: Serpent (South) to Jaguar (West) — Medicine Wheel

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The Practitioner as Nervous System Tracker

Somatic Experiencing is not a protocol-driven therapy in the way that EMDR or CBT are protocol-driven. It does not follow a rigid sequence of steps. It follows the body. The SE practitioner’s primary skill is tracking — moment-by-moment observation of the client’s autonomic nervous system through its visible manifestations: skin color, breathing pattern, muscle tone, eye movement, postural shifts, vocal quality, and the subtle somatic signals that reveal the nervous system’s state beneath the client’s verbal report.

This tracking capacity is what makes SE difficult to learn from a book and why SE training requires extensive clinical practice with direct supervision. The practitioner must develop what Peter Levine calls “somatic resonance” — the capacity to feel in their own body what is happening in the client’s body. This is not empathy in the colloquial sense (feeling sad when the client is sad). It is autonomic co-regulation at the physiological level: the practitioner’s nervous system attunes to the client’s nervous system and provides real-time information about the client’s state.

This article details the clinical structure of SE sessions, the specific techniques used in practice, the research supporting SE’s efficacy, and the clinical considerations for working with complex presentations.

Session Structure

Opening: Establishing Contact and Resource

Every SE session begins with establishing contact — not with the trauma, but with the present moment and with resources. The practitioner invites the client to arrive in the room:

“Take a moment to notice where you are. Feel the chair supporting you. Notice the temperature of the air. Look around the room and let your eyes settle on something that catches your attention.”

This is not merely rapport-building. It is neurobiological preparation. By directing attention to the present sensory environment, the practitioner activates the client’s orienting response — the brainstem mechanism that scans the environment for safety or danger. Orienting to a safe environment activates the ventral vagal system, creating the autonomic foundation for processing.

Resourcing: The practitioner then invites the client to connect with a resource — any experience, memory, sensation, or quality that evokes a sense of safety, calm, or wellbeing. Resources may include:

• A place that feels safe (real or imagined)
• A person or animal who provides comfort
• A body sensation associated with strength or groundedness
• A memory of mastery or accomplishment
• A spiritual or transpersonal connection

The practitioner helps the client deepen the resource by tracking its somatic expression: “As you think of that place, what do you notice in your body? Where do you feel that sense of calm? What’s happening with your breathing?” The resource is not merely imagined — it is somatically installed, becoming a felt experience that the client can return to throughout the session.

Middle: Tracking, Pendulation, and Processing

Once the resource is established, the practitioner invites the client to bring awareness to whatever is present — the issue they brought to session, a distressing memory, a current difficulty, or simply whatever the body is holding.

The Touch-and-Go Approach: The practitioner guides the client to touch the activation briefly and then return to resource. This is pendulation in action:

“Notice what happens in your body when you think about that situation… What do you notice? Where do you feel it?”

(Client reports tightness in the chest)

“Okay, just notice that tightness. Don’t try to change it. Just be curious about it. What is its quality? Its shape? Its temperature?”

(Client reports it feels like a fist-sized ball of pressure, hot)

“Good. And now, can you let that go for a moment and bring your attention to your feet on the floor? Or back to your resource? What do you notice when you shift your attention there?”

(Client reports the feet feel solid, grounded)

“Stay with that for a moment. Let yourself really feel that groundedness…”

(Pause)

“And now, gently, what happens if you bring a little attention back to that pressure in your chest? Has anything changed?”

This pendulation — activation to resource, resource to activation — is the fundamental rhythm of SE processing. Each cycle processes a small amount of the held activation and builds the nervous system’s capacity for flexible self-regulation.

Tracking Autonomic Activation

The practitioner observes the client’s autonomic state through multiple channels:

Skin color: Flushing (sympathetic activation, blood flow to muscles) versus pallor (dorsal vagal activation, blood withdrawal from periphery). Mottling or blotching may indicate autonomic instability.

Breathing: Rapid, shallow breathing (sympathetic) versus slow, deep breathing (ventral vagal) versus barely perceptible breathing (dorsal vagal). Spontaneous sighing or yawning indicates parasympathetic shift.

Muscle tone: Bracing, tension, rigidity (sympathetic, freeze) versus relaxation, softening (ventral vagal) versus collapse, limpness (dorsal vagal).

Eye contact: Steady, present eye contact (ventral vagal) versus darting, hypervigilant eyes (sympathetic) versus glazed, unfocused, or averted eyes (dorsal vagal).

Vocal quality: Warm, resonant, with prosody (ventral vagal) versus tight, pressured, high-pitched (sympathetic) versus flat, monotone, barely audible (dorsal vagal).

Micro-movements: Foot tapping, finger drumming, jaw clenching (sympathetic, incomplete flight or fight energy) versus stillness (freeze or ventral vagal) versus slumping, sinking (dorsal vagal).

The practitioner tracks these signals continuously and uses them to guide the session. When the client’s verbal report says “I’m fine” but their body shows pallor, shallow breathing, and glazed eyes, the practitioner follows the body: “I notice your breathing has gotten very quiet. What’s happening inside right now?”

Working with the Freeze Response

The freeze response presents unique clinical challenges because it involves simultaneous activation of the sympathetic and dorsal vagal systems — high energy trapped in an immobilized body. The person is charged but cannot move. They are terrified but cannot fight or flee. The clinical task is to slowly, carefully, titrate the release of the frozen energy.

Never break the freeze directly. The freeze response is a survival strategy. Breaking it suddenly — through intense activation, loud sound, or physical manipulation — can produce uncontrolled sympathetic discharge (panic, rage) that retraumatizes rather than heals.

Sequence: The SE approach to freeze follows a specific sequence:

1. Establish safety: Ensure the client knows they are safe, that they have control, that nothing will happen without their consent
2. Contact the freeze somatically: “Can you notice the stillness in your body? The places where you feel held or stuck? Just notice — don’t try to change anything”
3. Find the micro-movement: Within the freeze, there is always some movement — a slight trembling, a twitch, an impulse that begins but does not complete. The practitioner watches for and draws attention to this: “I notice your right hand just moved slightly. Can you feel that?”
4. Amplify the micro-movement: “What happens if you let that movement continue, just a little? Don’t force it — just allow whatever wants to happen”
5. Titrate the discharge: As the freeze begins to release, the sympathetic energy underneath begins to emerge — trembling, heat, agitation, impulses to move. The practitioner titrates: if the discharge is too fast (the client is becoming overwhelmed), they slow it by redirecting attention to resource. If it is too slow (the client is re-freezing), they gently re-contact the activation.
6. Support the completion: The defensive response that was frozen (the fight that could not happen, the flight that was prevented) completes through spontaneous movement. The arms may push, the legs may kick, the voice may emerge. The practitioner supports these completions with encouragement and tracking: “That’s it. Let your arms do what they need to do.”

Working with Dissociation

Dissociation — the dorsal vagal shutdown that disconnects awareness from the body — is common in clients with trauma histories. The dissociated client is “not home” — their eyes are unfocused, their breathing is minimal, their affect is flat, and their verbal responses are detached or absent.

SE’s approach to dissociation:

Do not push the client back into their body. Forced grounding (“Feel your feet!”) can be experienced as threatening by a nervous system that dissociated precisely because being in the body was unsafe.

Meet the client where they are: Acknowledge the dissociation as a survival response. “It makes sense that a part of you would go somewhere else. Your body learned that leaving was the safest option.”

Work with the edges: Rather than trying to resolve the dissociation directly, work with its periphery. “Can you notice the sensation in just your fingertips? Not your whole body — just your fingertips.” This tiny request is often tolerable even for the highly dissociated client, and it begins the process of reconnecting awareness with the body.

Use external resources: The room, the practitioner’s voice, visual anchors in the environment. “Can you see me? Can you hear my voice? You are here, in this room, in this chair.”

Be patient: Dissociation took time to develop and takes time to resolve. The SE approach is gradual: expand body awareness slowly, from the periphery to the core, from external sensing to internal sensing, from brief moments of embodiment to sustained presence.

Specific SE Techniques

Grounding

Grounding connects the client to the present moment through sensory contact with the physical environment:

• Feet on floor: “Feel the pressure of the floor against the soles of your feet. Push down slightly and notice the solidity.”
• Back against chair: “Feel the chair supporting your back. Let your weight settle into it.”
• Hands on thighs: “Feel the warmth and weight of your hands on your thighs.”
• 5-4-3-2-1: Name 5 things you can see, 4 things you can hear, 3 things you can touch, 2 things you can smell, 1 thing you can taste

Grounding is a ventral vagal activation strategy — it brings the client into present-moment sensory awareness, which activates the orienting response and the social engagement system.

Containment

When activation exceeds the client’s processing capacity, containment prevents overwhelm:

• Imaginal container: “Imagine placing that sensation/memory/feeling in a container — a box, a safe, a vault. You can come back to it later, when you’re ready.”
• Physical containment: The client can place their hands on their abdomen (self-holding) or the practitioner can offer gentle, consensual touch (hand on shoulder, feet grounded by practitioner’s hands on the client’s feet)
• Boundary: “Imagine drawing a line around that sensation. It stays on its side. You stay on yours.”

Orientation

Orienting — the act of looking around the environment — activates the brainstem orienting response and shifts the nervous system out of freeze:

• “Let your eyes slowly look around the room. Don’t look for anything specific — just let your eyes be drawn to whatever catches them.”
• “Is there anything in the room that your eyes want to rest on? Stay with that for a moment.”
• “Can you look toward the door? Toward the window? Notice that there are exits.”

The orienting response is the neurological opposite of the freeze response. In freeze, the orienting response is suppressed — the animal stops scanning and becomes immobile. Reactivating the orienting response begins to release the freeze.

Resourcing with Touch (practitioner touch)

SE practitioners trained in touch skills may use gentle, consensual physical contact to support processing:

• Hand on the back: Supporting the spine, the body’s structural core. This can help the client feel “backed up,” supported, held.
• Feet held: Grounding the client physically, providing a felt sense of contact with the earth.
• Hands held: Providing the social engagement contact that activates the ventral vagal system.

All SE touch is consensual, explained in advance, and can be withdrawn at any time. The practitioner monitors the client’s response: does the touch produce settling (good) or activation (the touch is triggering and should be withdrawn)?

Research Evidence

Payne, Levine, and Crane-Godreau (2015)

Peter Payne, Peter Levine, and Mardi Crane-Godreau published a seminal theoretical paper in Frontiers in Psychology outlining the neurobiological basis of SE. They argued that SE works through interoception (the brain’s representation of internal body states) and proprioception (the brain’s representation of body position and movement). By directing the client’s attention to interoceptive and proprioceptive signals, SE activates the insular cortex — the brain region that integrates body sensation with emotional meaning — and facilitates the reconsolidation of traumatic memories at the body level.

Their model proposes that SE’s core mechanisms include:

1. Interoceptive awareness: Developing the capacity to sense and describe internal body states (the “felt sense”)
2. Pendulation-enhanced self-regulation: Building the nervous system’s capacity for flexible oscillation between activation and settling
3. Completion of arrested defensive responses: Allowing the body to perform the fight/flight/orientation movements that were interrupted during trauma
4. Discharge of survival energy: Releasing the accumulated sympathetic activation through trembling, shaking, heat, and spontaneous movement

Brom et al. (2017)

Danny Brom and colleagues conducted a randomized controlled outcome study comparing SE to a waitlist control for PTSD. Published in the Journal of Traumatic Stress, this study is the most rigorous clinical trial of SE to date. Results:

• 44.1% of SE participants no longer met PTSD criteria post-treatment, compared to 27.6% of waitlist controls
• SE produced significant reductions on all PTSD symptom clusters: re-experiencing, avoidance, and hyperarousal
• Depression and anxiety also improved significantly in the SE group
• Treatment gains were maintained at follow-up

While the effect sizes were moderate, the study established SE as an empirically supported treatment for PTSD — a significant achievement for a body-based therapy in a research field dominated by cognitive-behavioral interventions.

Brom’s Comparison with CBT

Brom and colleagues’ research also provided indirect comparison data with cognitive-behavioral therapies. While direct head-to-head trials between SE and CBT remain limited, the available evidence suggests that SE may work through different mechanisms than CBT, producing similar symptom reduction but with greater changes in body awareness, interoceptive accuracy, and autonomic flexibility. This is consistent with the hypothesis that SE and CBT address different dimensions of the trauma response: CBT addresses the cognitive-behavioral dimension, SE addresses the sensory-autonomic dimension.

Polyvagal Integration

SE and polyvagal theory share a common understanding of the nervous system’s hierarchical organization. Porges (2011) describes the polyvagal hierarchy: ventral vagal (social engagement, safety) > sympathetic (mobilization, danger) > dorsal vagal (immobilization, life-threat). SE’s clinical approach follows this hierarchy in reverse: working from dorsal vagal (freeze/collapse) through sympathetic (fight/flight) to ventral vagal (safety/connection).

Deb Dana’s Autonomic Ladder: Dana (2018) developed the “autonomic ladder” — a clinical tool that maps the polyvagal hierarchy onto felt experience. Clients learn to identify their current position on the ladder:

• Top (Ventral Vagal): Safe, connected, curious, present. “I’m here. I can handle this.”
• Middle (Sympathetic): Mobilized, anxious, angry, activated. “Something is wrong. I need to act.”
• Bottom (Dorsal Vagal): Collapsed, numb, disconnected, hopeless. “Nothing matters. I can’t.”

The SE practitioner uses this ladder as a tracking framework, noting when the client moves up or down the ladder and intervening accordingly:

• If the client is at the bottom (dorsal vagal), the practitioner works to bring them up to sympathetic — gently activating through orienting, micro-movement, or resource contact
• If the client is in the middle (sympathetic), the practitioner supports completion and discharge of the mobilization energy, facilitating the return to ventral vagal
• If the client is at the top (ventral vagal), the practitioner can support processing from this resourced place — the client has the capacity to approach activation without being overwhelmed

The Vagal Brake

Porges describes the “vagal brake” — the myelinated ventral vagal nerve’s capacity to rapidly modulate heart rate in response to environmental demands. When the vagal brake is engaged, heart rate is low and heart rate variability is high — the person is calm, flexible, and socially engaged. When the vagal brake is released, heart rate increases and the sympathetic system takes over.

SE pendulation exercises the vagal brake. Each cycle of activation (vagal brake released) and settling (vagal brake re-engaged) strengthens the nerve’s capacity for rapid, flexible modulation. Over time, the client develops a more responsive vagal brake — a nervous system that can handle activation without becoming overwhelmed and can settle efficiently after challenge.

Functional Medicine Connections

SE’s focus on autonomic regulation places it at the intersection of trauma therapy and functional medicine:

HPA Axis: Chronic sympathetic activation maintains elevated cortisol, which produces a cascade of physiological effects: insulin resistance, immune suppression, gut permeability, neuroinflammation. SE’s resolution of chronic sympathetic activation may normalize cortisol patterns, addressing the root of this cascade.

Gut-Brain Axis: The vagus nerve — the primary mediator of the gut-brain axis — is the central target of SE’s clinical work. By shifting autonomic state from sympathetic dominance to ventral vagal dominance, SE may improve vagal tone, which directly modulates gut motility, digestive enzyme secretion, gut barrier integrity, and the gut microbiome (through vagal modulation of the immune system’s interaction with intestinal bacteria).

Inflammation: Chronic sympathetic activation and dorsal vagal collapse both contribute to systemic inflammation through different mechanisms. Sympathetic activation increases pro-inflammatory cytokines (IL-6, TNF-alpha) through catecholamine-mediated immune activation. Dorsal vagal collapse reduces anti-inflammatory vagal signaling. SE’s restoration of ventral vagal dominance may reduce inflammation by rebalancing these autonomic influences.

Pain: Central sensitization — the nervous system’s amplification of pain signals — is maintained by chronic sympathetic activation. SE’s capacity to resolve autonomic dysregulation may reduce central sensitization and the chronic pain it produces.

TCM Connections

SE’s concept of “stuck” survival energy parallels TCM’s concept of qi stagnation. In both frameworks:

• Energy that should flow is blocked
• The blockage produces symptoms (pain, emotional disturbance, functional impairment)
• Treatment involves releasing the blockage and restoring flow
• The release is experienced somatically (heat, trembling, movement, emotional discharge)

Specific TCM parallels:

• Fight energy stuck = Liver qi stagnation (anger, tension, frustration)
• Flight energy stuck = Kidney qi deficiency/fear (anxiety, restlessness, inability to settle)
• Freeze = Qi/blood stagnation (pain, immobility, emotional numbness)
• Collapse = Yang deficiency (fatigue, withdrawal, depression)

Acupuncture points that release these patterns may complement SE processing. Liver 3 (Tai Chong) for stuck fight energy. Kidney 1 (Yong Quan) for grounding and settling fear. Du 20 (Bai Hui) for lifting collapse. Pericardium 6 (Nei Guan) for calming the heart and restoring social engagement.

The SE practitioner who understands TCM can see the same patterns through two lenses, and the acupuncturist who understands SE can recognize when needle-induced qi release is facilitating the completion of a frozen defensive response.

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References

Brom, D., Stokar, Y., Lawi, C., Nuriel-Porat, V., Ziv, Y., Lerner, K., & Ross, G. (2017). Somatic experiencing for posttraumatic stress disorder: A randomized controlled outcome study. Journal of Traumatic Stress, 30(3), 304-312.

Dana, D. (2018). The Polyvagal Theory in Therapy: Engaging the Rhythm of Regulation. W. W. Norton.

Gendlin, E. T. (1978). Focusing. Everest House.

Levine, P. A. (1997). Waking the Tiger: Healing Trauma. North Atlantic Books.

Levine, P. A. (2010). In an Unspoken Voice: How the Body Releases Trauma and Restores Goodness. North Atlantic Books.

Payne, P., Levine, P. A., & Crane-Godreau, M. A. (2015). Somatic experiencing: Using interoception and proprioception as core elements of trauma therapy. Frontiers in Psychology, 6, 93.

Porges, S. W. (2011). The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-Regulation. W. W. Norton.

van der Kolk, B. A. (2014). The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. Viking.