Somatic Processing with Neurodivergent Clients

Over the past decade advances in neuroscience and changing cultural and social approaches to wellbeing have brought us a much greater understanding and acceptance of neurodiversity, and the range of different neurotypes. We now understand that the human nervous system is infinitely complex and advanced, and can present in a huge number of ways, across an entire spectrum of emotional experience and expression.

This understanding has hopefully translated into more neurodivergent clients coming into therapy, and feeling that therapy can be a safe place where they can make sense of where they fit on this spectrum. For these clients therapy can offer an opportunity to start to experience their nervous systems in a different way, to learn to manage their feelings, and to think about how they can share their inner world with others. We know that the ‘state precedes the story’, so being able to recognise the state of our nervous system can help us to make sense of the signals it is sending, and to understand the source of the feelings, thoughts, or behaviours we may subsequently experience.

So, how do we work with these clients? Some therapists who are used to traditional talk therapy methods may find these approaches quite ineffective as they start to see more neurodivergent clients. These clients may instead prefer to process non-verbally, using alternative methods such as sandplay therapy, art therapy, or other models of expression.
 

Developing the skill of Interoception

One approach which can be particularly useful with neurodivergent clients is Somatic Processing; helping clients to develop the skill of Interoception, whereby they can start to recognise the body’s internal signals, and translate these messages to certain emotional experiences. Developing this interoceptive ability can have a huge impact on mental wellbeing, as it means clients are able to play a more active role in understanding their own feelings, rather than feeling like a helpless bystander.

Therapists such as Bessel Van Der Kolk, Peter Levine, Gabor Mate, and Stephen Porges have led the way in increasing our understanding of the mind-body union, encouraging practitioners to work with the client’s whole self in therapy and to understand the body’s role in mental health.

A simple way to begin Somatic Processing might be to invite a client to gently pay attention to what they notice in their body during a session. When starting out, it may be useful to ask very specific questions to help neurodivergent clients start to explore and make sense of their inner world:
 

• Are there any specific bodily sensations that stand out?
• Is there an area that seems to be drawing attention to itself?
• Or, conversely, are there areas that feel numb, or out of touch?
• If the parts of the body had a voice, what might they be saying right now?
• What is the temperature inside the body, and does this fluctuate?
• What do they notice if they focus on each of their five senses – sight, sound, smell, taste, touch – one at a time?
• Is there an urge to move, or to be still? Would the body feel more comfortable sitting, lying down, or standing?
• Does their sensory experience change if they have their eyes open or eyes closed?
• How does it feel to be present with the body in this way?
   

Many clients may report feeling “nothing”, or struggling with these exercises at first. This is not surprising, if they have become used to dissociating from their body and physical self. This numbness can often result from early childhood experiences of sensory overload and feeling over-stimulated, and thus learning to shut down and distance from the body’s signals. Many neurodivergent clients have spent years learning to mask their internal experiences in order to comply with social norms and demands. It is therefore vital that we start slowly; dipping our toe into the water of emotion, rather than jumping straight in at the deep end.

Resourcing, titration and pendulation

We can start by resourcing our clients, using exercises such as deep breathing, placing both feet on the floor to feel more grounded, or placing hands across the body and onto the shoulders to have a sensation of feeling held and secure. Once this bodily resource is in place, we can gently practise titration and pendulation skills; swinging into feelings of discomfort before straight coming back to resource, as and when needed.

This is a form of exposure therapy, and over time we co-regulate with the client, to build a resilience and sense of safety when engaging with the nervous system and the body’s internal signals, and how to make sense of these needs. This work can be transformative, as we give these clients a new way of relating to their own experience, and being able to process and discharge a lifetime of emotions.