In Therapy but the Body Still Feels Frozen: Combining Talk With Somatic Work
Updated: 17 hours ago
If you have spent months or years in therapy, understand exactly where your reactions come from, and still go rigid, numb or blank when something sets you off, that gap is common and it does not mean you have failed at therapy. Insight and a calmer body are two different things, and they do not always arrive together. Adding body-focused work to talking therapy is a reasonable step, and the first randomised trials of somatic approaches are encouraging. The evidence is still much thinner than for the trauma-focused therapies that guidelines recommend first. For most people, the strongest combination is a trauma-focused therapist who also pays attention to the body, or a talking therapist and a somatic practitioner who know about each other.
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What "frozen" usually means
The breath goes shallow, the shoulders lock, the voice disappears in an argument, or the whole body feels far away. Some people go stiff and alert, others limp and foggy.
Researchers describe a set of automatic defence responses that run without asking permission. In a 2015 review in the Harvard Review of Psychiatry, Kasia Kozlowska and colleagues set out what they call the defence cascade: arousal, then fight or flight, then freezing, and in extreme danger a state called tonic immobility, in which the body goes still and less responsive. Freezing in this sense is a heightened, watchful stillness, ready to move. Tonic immobility is closer to shutting down.
These responses are fast and they are not chosen. That is the key point for anyone who feels frustrated with themselves. You cannot argue a reflex out of existence, which is part of why understanding your history, however well, does not automatically switch the reflex off.
A note on a popular explanation. Many websites explain freezing through polyvagal theory and its "dorsal vagal shutdown". The language can be useful in a session, but the physiology behind it is disputed. In 2023 the psychophysiologist Paul Grossman argued in Biological Psychology that the theory's basic premises are likely wrong, and the debate continues. You do not need the theory to take the experience seriously.
Freezing also has ordinary causes. Exhaustion, poor sleep, depression, some medicines and a thyroid that is out of balance can all leave the body flat and slow. If the numbness is new or getting worse, a GP or physician is worth a visit before you put it all down to the past.
Small things to try in the moment
These are not treatment. They are short, safe ways to give a frozen body a little room, and you can stop any of them at once.
Look around the room. Let your eyes move slowly and name three things you see. Freezing narrows attention; orienting widens it again.
Find your feet. Press them into the floor for a few seconds, then let go. Notice the difference.
Make the out-breath longer. Breathe in normally and breathe out a little slower, without forcing anything.
Move something small. Turn your wrists or roll your shoulders. Small movement tells the body it is allowed to move.
If any of these makes things worse, stop. That is useful information to bring to your therapist.
Why talking alone sometimes does not reach it
Talking therapy works mostly through meaning: you put events into words, notice patterns, and change how you relate to them. That helps a great deal, and for post-traumatic stress disorder it is the backbone of the best-tested treatments.
What talking does less directly is change what happens in the body in the moment. Some people also find that talking about hard memories pushes them past what they can handle, so they go numb in the session itself and leave feeling worse. Others talk fluently about everything and feel nothing, because the talking has become a way of staying safely above the body.
None of this means talking therapy is the wrong tool. It means the therapy may need to slow down, include the body, or both.
Check first: are you getting trauma-focused therapy?
Before adding something new, it is worth asking what kind of therapy you are in. General supportive counselling and trauma-focused therapy are different things. The guidelines below are written for post-traumatic stress disorder; if you have no diagnosis, they are still a good guide to what is well tested.
In the UK, NICE guideline NG116 recommends trauma-focused cognitive behavioural therapy and EMDR (eye movement desensitisation and reprocessing) for adults with post-traumatic stress disorder. In England you can refer yourself to NHS Talking Therapies, or ask your GP.
In the US, guidelines from the American Psychological Association and from the VA and Department of Defense put trauma-focused therapies first, in particular cognitive processing therapy and prolonged exposure. EMDR is among the recommended options as well, more firmly in some guidelines than in others. A 2018 review by Laura Watkins and colleagues gives a readable overview of these treatments.
These therapies are not purely "talk". Prolonged exposure and EMDR deliberately work with what you feel in your body while you recall a memory. If you have been in general counselling for years with the freeze unchanged, asking about a trauma-focused approach may help more than adding a separate body practice. It is a fair question to put to your therapist, and not a criticism of them. You could say something like: "I understand much more than I did, but my body still locks up. Can we work with that more directly here, or would you support me adding body-focused work alongside our sessions?"
What somatic therapy is
"Somatic" simply means relating to the body. Several distinct methods sit under the label:
Somatic Experiencing, developed by Peter Levine, works with small doses of body sensation, pendulating between activation and calm, and sometimes uses touch.
Sensorimotor Psychotherapy, developed by Pat Ogden, combines talking with close attention to posture, movement and impulses in the body.
Body psychotherapy is an older umbrella term for therapies that work with the body as part of psychotherapy.
Trauma-sensitive yoga is a movement practice adapted for people with trauma, with choice and control built into every instruction.
A session usually feels slower than talk therapy. The practitioner may ask what you notice in your hands or chest, invite you to feel your feet on the floor, or pause the conversation when your breathing changes.
What the evidence shows, and where it stops
The honest summary is: promising, small, and not yet enough to replace trauma-focused therapy.
Somatic Experiencing. The first randomised trial, by Danny Brom and colleagues in the Journal of Traumatic Stress in 2017, gave 63 adults with PTSD either 15 sessions or a waiting list. The treated group improved substantially more, and 44 per cent no longer met the criteria for PTSD after treatment. The authors themselves name the limits: a small sample and no comparison with another therapy. A 2021 scoping review by Marie Kuhfuß and colleagues in the European Journal of Psychotraumatology found 16 studies and called the results promising but in need of more unbiased randomised research.
Trauma-sensitive yoga. In a 2014 trial led by Bessel van der Kolk in the Journal of Clinical Psychiatry, 64 women with chronic PTSD that had not responded to treatment took a weekly yoga class or a health education class for ten weeks. At the end, 52 per cent of the yoga group no longer met PTSD criteria, compared with 21 per cent in the comparison group. Both groups improved, and yoga was offered alongside existing treatment, not instead of it.
Body psychotherapy. A 2021 meta-analysis by Sophie Rosendahl and colleagues in Frontiers in Psychiatry pooled 18 randomised trials across different conditions and found medium effects on psychological distress. The trials were varied and many were small.
Sensorimotor Psychotherapy is widely taught, but randomised trials are scarce.
So claims such as "trauma is stored in the body and somatic therapy releases it" or "trauma treatment always works better with the body" go further than the studies do. What the research does support is that body-focused work helps some people, especially as part of a wider treatment.
How to combine the two well
There are two workable set-ups.
One practitioner who does both. Some licensed psychotherapists and psychologists have additional training in a somatic method. This keeps everything in one relationship, which matters when trauma is involved.
Two practitioners who know about each other. You keep your talking therapist and add a somatic practitioner. Tell both. With your permission, they can agree who works on what. Without that, two people may unknowingly open the same material from two sides, and you carry the load in between.
Some practical points:
Pace matters more than method. Good somatic work stays within what you can tolerate. If you leave sessions shaky, numb or flooded for days, tell the practitioner and slow down.
Touch is optional. Some somatic methods use touch. You can say no at any point, and a good practitioner asks before every contact rather than once at the start.
Watch for dissociation. If you often lose time or feel completely unreal, tell your therapist before starting somatic work. Dissociation needs careful pacing and a clinician who knows how to work with it.
Who can call themselves a somatic practitioner
This is where people get caught out. Certificates in Somatic Experiencing, Sensorimotor Psychotherapy or trauma-sensitive yoga are training credentials. On their own they are not a licence to treat mental health conditions.
In the UK, "practitioner psychologist" titles are protected and regulated by the HCPC. Counsellors and psychotherapists are not statutorily regulated, but you can check the BACP and UKCP registers, and UKCP includes body psychotherapists. Someone with a somatic certificate and a professional registration offers more safeguards than someone with the certificate alone.
In the US, check your state licensing board to confirm that a psychologist, licensed professional counselor, clinical social worker or marriage and family therapist holds a current licence. A somatic practitioner without a licence can still be a good fit for body-based support, but should not be your only help for PTSD.
Questions worth asking at the first contact:
What training do you have in trauma, and how long was it?
Are you registered or licensed, and with whom?
How do you work if I go numb or overwhelmed in a session?
Do you use touch, and how do you ask?
Are you willing to coordinate with my therapist?
Where Spine App fits
Spine App is a companion for body, mind and spirit that shows conventional and holistic support in one search. That suits this exact situation: you can look for a trauma-focused therapist and a somatic practitioner in the same place, and choose conventional, holistic or both with one filter.
Besides practitioners, you will find sessions, events and podcasts about somatic work. You see a practitioner's free times and book your session through Spine App, with every amount shown before you pay. Some profiles carry a verification badge, which is voluntary and means the team has checked identity or qualification, so it still pays to ask the questions above. Instead of star ratings, there are experience reports by invitation. Physicians are found through Google Maps; other practitioners appear when they are on Spine App. Browse practitioners and see who is available.
Sources
Helplines: Samaritans, 988 Suicide & Crisis Lifeline
Frequently Asked Questions
Why do I still freeze when I understand my trauma?
Freezing is an automatic defence response, not a decision, so insight alone rarely switches it off. Trauma-focused therapies and body-focused work both aim at what happens in the moment rather than only at understanding it.
Can I do somatic therapy while I am in talk therapy?
Yes, and many people do. Tell both practitioners, and with your permission let them agree who works on what, so you are not processing the same material from two sides without anyone noticing.
Is somatic therapy evidence-based?
Partly. A 2017 randomised trial of Somatic Experiencing and a 2014 trial of trauma-sensitive yoga showed clear improvements, and a 2021 meta-analysis found medium effects for body psychotherapy. The studies are small, and somatic therapy is not yet a first-line treatment in UK or US guidelines.
What is the difference between Somatic Experiencing and Sensorimotor Psychotherapy?
Somatic Experiencing, developed by Peter Levine, works mainly with small doses of body sensation and sometimes touch. Sensorimotor Psychotherapy, developed by Pat Ogden, blends talking therapy with attention to posture, movement and impulses. Somatic Experiencing has more trial data.
Is a Somatic Experiencing Practitioner a licensed therapist?
Not automatically. The certificate is a training credential. Check whether the person is also licensed by a US state board, registered with the HCPC, or a member of BACP or UKCP in the UK.
What should I try first if my therapy has stalled?
Ask whether your current therapy is trauma-focused. If it is not, trauma-focused CBT, cognitive processing therapy, prolonged exposure or EMDR may help more than adding something separate. Body-focused work can then be added at a pace you can manage.
Is polyvagal theory proven?
No. It is popular in therapy, but its physiological premises are contested by researchers, including in a detailed 2023 critique in Biological Psychology. The experience of freezing is real either way.
About Spine App
Spine App is a free life companion app for your health: it connects you with real practitioners – conventional, holistic or both – lets you book sessions directly, and checks in afterwards to ask what helped.
Written by the Spine App Editorial Team. Last updated October 2026.
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