There are a number of factors that come into play when we look at the development of trauma-related disorders and post-traumatic stress disorders among our clients. In addition to the traumatic event or experience, an individual’s overall Mental Health, coping skills, support, and environment impact the development of the mental health symptoms that they will experience. Keep reading to learn 45 Somatic Therapy questions to ask clients in sessions.

PTSD and other related concerns have been a focus of research to ensure that we provide the best possible care to our clients who are affected by it. With 1 in every 11 Americans developing PTSD in their lifetime, this is a mental health concern that is more frequent than the general public may be aware of. With added research, we have been able to learn about a variety of therapeutic approaches that have a positive impact on the presence of PTSD symptoms, and the overall quality of life for those who are impacted by it. Having a variety of therapeutic approaches to use allows clinicians to choose an approach that would best suit their client’s unique needs.

Somatic Experiencing Therapy (SE) is a therapeutic approach for post-traumatic stress and chronic stress for over 45 years. Other mental health concerns that can benefit from SE include complicated grief, depression, anxiety, trust, intimacy challenges, and self-esteem concerns. This therapeutic intervention has not gained the publicity and recognition that other approaches have received; however, it is an effective treatment option for mental health professionals to use.

SE focuses its attention on how our emotions appear within our bodies. Research has shown that somatic therapy can be effective with those who have a history of trauma, and those who don’t. Additionally, this can be an effective approach for clients who do not obtain ideal clinical outcomes after the use of exposure therapy and other cognitive therapies that are commonly used in PTSD treatment.

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Somatic Experiencing Therapy believes that PTSD symptoms occur because a person’s internal stress system is on high alert because of the trauma that they experienced. This is one of the reasons that individuals can find themselves struggling with emotional regulation. It is important to remember that personal differences will impact the specific symptoms your client experiences, as well as the severity of their distress.

With the use of SE, mental health professionals work to help their clients change their trauma-related stress response by focusing on their internal sensations instead of their thoughts and emotions. This approach is known as bottom-up processing and is a vital component of SE. After developing a sense of safety, clients can learn that they are safe in the present moment, and recognize that the danger they are responding to is from past experiences.

Somatic questions can be used during the use of various techniques and exercises including:

• Body awareness
• Titration and Pendulation
• Resourcing
• Acupressure
• Breathwork
• Grounding
• Hypnosis

Getting Ready for Your First Somatic Therapy Session with a New Client

If you are an experienced clinician, you may have your own routine you engage in before meeting with a client for the first time. This can include reviewing the paperwork you will be completing, gathering assessments, and reviewing any paperwork you received about your client such as screeners and referrals from other healthcare professionals.

During your first session, your focus will be to determine if you and the client are a good fit to work together, and if they would benefit from the use of Somatic Experiencing Therapy. You will spend time learning about your client’s health history, traumas, and expectations of treatment, and assess how their nervous system is currently working. Somatic questions used during your initial session can be used to help gather information about your client’s world. 

SE interventions may involve brief moments of contact between the client and therapist, which could be triggering for some clients. It is important to develop a strong therapeutic relationship involving safety and trust to receive the optimal outcomes of SE.

Another topic worth mentioning is the importance of your own self-care. Research has shown that an estimated 40% of mental health professionals experience emotional exhaustion which can contribute to burnout.  Because of this, we encourage you to be mindful of your own mental health and needs. Self-care practices do not need to be extravagant measures, instead think of them as realistic steps that you can take to promote your own mental health and wellness. Supervision can be a great place to explore your emotional experiences that may be related to burnout and explore strategies you can take to prevent further distress. 

Somatic Therapy Questions to Ask Clients

Somatic questions can be used to enhance a client’s clinical experience and to guide discussion in therapy sessions. Examples of Somatic questions in therapy include:

1. What sensations do you feel in your body when you feel comfortable?
2. What changes occur in your body when you feel safe?
3. Do you notice any changes in the tension you are holding when you feel safe?
4. Can you describe a safe place for you?
5. What helps you feel safe?
6. Can you tell me about your breathing at this moment?
7. What changes have you noticed in your breathing?
8. What breathing practices have you found to be helpful?
9. What can you share with me about grounding practices?
10. Are there any grounding exercises that you have found useful?
11. If I ask you to describe a time when someone showed you kindness, what would you share with me?
12. What changes did you notice within your body when they showed you kindness?
13. What changes do you notice within your body when you show yourself kindness?
14. How can you show yourself kindness today?
15. Can you share with me a time when you felt comfortable in your own skin?
16. What do you think helped you feel comfortable at that time?
17. How did that level of comfort impact your overall sense of distress?
18. What changes have you noticed within your body when you move?
19. Are there any particular movements that you enjoy?
20. Can you share with me the movements that reduce your emotional distress?
21. How would you describe your posture?
22. Can you describe your typical breathing patterns?
23. Tell me about your heart rate; do you notice it speeding up or slowing down?
24. Where in your body do you carry tension?
25. Do you have awareness when your body is tense?
26. What helps you release the tension your body holds onto?
27. Can you share with me objects, people, or things that help you feel calm?
28. What experiences, people, or things are triggering for you?
29. Can you share with me a recent experience when you were triggered?
30. What can you tell about situations/people/ or events that trigger you?
31. What changes do you notice within yourself when you are triggered?
32. How did you cope with or manage that situation?
33. If I ask you to take a few deep breaths, can you describe what you feel within your body? How about what you feel around you?
34. Where in your body did you begin to feel that emotion/stress/tension?
35. Did that stress or tension move to other parts of your body?
36. Did you notice any changes in your body temperature? Any warning or cooling sensations?
37. Can you describe what you are feeling in your body at this moment?
38. Based on what you are feeling, do you have an idea of what you need today?
39. What would it be like for you to check in with your body throughout your day?
40. When do you feel a good time would be to check in with your body during your day?
41. (After using the Voo Sound Exercise) After this exercise, did you find yourself feeling a calmness or an activation within your body?
42. What did you notice about your overall experience with this exercise?
43. Are there any concerns that you had since our last session?
44. Can you share with me something positive that happened since the last time we spoke?
45. How do you feel you have been checking in with your body since our last session?

Final Thoughts on Asking the Right Questions in Somatic Therapy

Thank you for taking the time to read our article about somatic questions that can be used during therapy sessions! SE is still gaining the research backing that other therapeutic approaches, such as cognitive behavioral therapies, already have. This does not, however, take away from the positive impact that SE can have on clients who are living with PTSD and other trauma-related concerns. With time, SE will gain a stronger empirical backing and continue having a positive impact on client’s mental health and wellness.   

If you feel as though SE has sparked an interest for you, or you would like to learn more about its application and benefits, we encourage you to look into the different Continuing Education and other training opportunities in your area. Additionally, we encourage you to read up on the competency requirements for your clinical field before applying a new approach to your clinical work, as there may be different expectations and requirements compared to other fields.

TherapyByPro is an online mental health directory that connects mental health pros with clients in need. If you’re a mental health professional, you can Join our community and add your practice listing here. We have assessments, practice forms, and worksheet templates mental health professionals can use to streamline their practice. View all of our mental health worksheets here.

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Resources:

• Kuhfuß, M., Maldei, T., Hetmanek, A., & Baumann, N. (2021). Somatic experiencing – effectiveness and key factors of a body-oriented trauma therapy: a scoping literature review. European journal of psychotraumatology, 12(1), 1929023. https://doi.org/10.1080/20008198.2021.1929023
• O’Connor, K., Muller Neff, D., & Pitman, S. (2018). Burnout in mental health professionals: A  systematic review and meta-analysis of prevalence and determinants. European psychiatry : the journal of the Association of European Psychiatrists, 53, 74–99. https://doi.org/10.1016/j.eurpsy.2018.06.003
• Salamon, M. (2023, July 7). What is somatic therapy?. Harvard Health. https://www.health.harvard.edu/blog/what-is-somatic-therapy-202307072951  
• What is posttraumatic stress disorder (PTSD)?. Psychiatry.org – What is Posttraumatic Stress Disorder (PTSD)? (n.d.-a). https://www.psychiatry.org/patients-families/ptsd/what-is-ptsd#:~:text=PTSD%20affects%20approximately%203.5%20percent,as%20men%20to%20have%20PTSD  

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