Trauma doesn’t always come with words. It can show up in the body, affect the nervous system, and shape how clients experience safety and connection. Yet traditional talk therapy may not always reach the experiences clients struggle to put into words.
In this Q&A, Lisa Maestri explores how somatic and expressive approaches can help clinicians move beyond verbal processing, support nervous system regulation, and help clients reconnect with their bodies at a pace that feels safe. Her insights offer a valuable perspective on expanding our therapeutic toolbox and creating new pathways toward healing.
1. When Trauma is Held in the Body
Q: Trauma can affect people in ways that aren't always accessiblethrough words alone. From your clinical experience, what are some of the waysunresolved trauma can show up in the body, behavior, or nervous system — andwhy is it important for clinicians to recognize those signs?
Lisa: We frequently see that the body often tells the story before our clients can. For many, they will describe their history in a detached way, but we can recognize that their nervous system and body are saying something very different.
Trauma can and will manifest as chronic tension, especially in the jaw, neck or shoulders, through stomach and GI issues, and headaches and fatigue. It can also show up in our clients’ nervous system through hypervigilance, a strong startle response, trouble sleeping, or shifting between feeling flooded or numb. When we are able recognize these symptoms as survival responses rather than resistance, we can begin to slow down, build safety first, and help clients reconnect with their bodies at a pace their nervous system can tolerate. If we go too quickly, we run the risk of our clients ending therapy prematurely.
2. Moving Beyond Talking
Q: Talk therapy can be incredibly valuable, but some clients may struggle to put their experiences into words. What can somatic and expressive approaches offer clients that traditional verbal processing may not always be able to reach?
Lisa: A lot of what clients carry has never been verbally processed. Talk therapy can make clients feel like they are required to translate these experiences into words, which can create a flight/flight/freeze response and leave clients feeling confused or helpless. This is a top-down approach.
Somatic and expressive approaches change the entry point and can reduce the pressure to have the “right words or recollections.” Somatic interventions help clients regulate their nervous system through techniques that encourage containment and grounding first.
3. Helping Clients Feel Safe in Their Bodies
Q: Trauma can disrupt a person's sense of safety and connection to their body. What are some ways clinicians can help clients begin to reconnect with their bodies and develop greater awareness and regulation without pushing them beyond what feels safe?
Lisa: Going slow with our clients is key. I always like to offer a variety of options and remind clients that it’s ok if they aren’t ready to engage in a particular strategy. It is important to allow clients to set the pace, and safety always come first. Reconnecting with the body works best when it’s invitational, gradual, and anchored in choice, because the body itself may be where the danger was experienced. It is important to check in with our clients often and to create a stop signal when they need to stop.
Reconnection is gradual and nonlinear, built through many small experiences of safety. Celebrating small shifts, such noticing their feet on the floor, catching an early stress signal, or taking a breath that feels slightly easier, helps clients see progress that might otherwise feel invisible. A trauma-informed approach doesn’t aim to get clients “back into their bodies.” Rather, it is to help them discover, at their own pace, that the body can become a place of information, choice, and eventually safety again.
4. Expanding the Clinician's Toolbox
Q: Every client responds differently to therapy, and having a variety of approaches can give clinicians more ways to meet clients where they are. How can incorporating somatic and expressive modalities expand a clinician's therapeutic toolbox, and what possibilities might open up when we become more comfortable thinking beyond traditional talk therapy?
Lisa: Adding somatic and expressive modalities isn’t meant to replace talk therapy. It widens the doorways into the work. When clinicians can move between words, body, image, and movement, there are more ways to meet clients where they are, rather than asking every client to fit one format. When a client dissociates, becomes flooded, or intellectualizes, a clinician with a wider repertoire will be able to shift to grounding, movement, drawing, or working with an object instead of pushing harder on verbal processing. We are helping to enhance our clients’ widow of tolerance in therapy.
5. The Power of Creativity in Clinical Work
Q: For some clinicians, incorporating art, movement, or other creative approaches into therapy may feel outside the traditional boundaries of clinical practice. What have you learned about the therapeutic power of creativity, and why can these approaches be particularly meaningful for clients who have experienced trauma?
Lisa: The biggest thing I’ve learned is that trauma doesn’t live only in the story. It lives in our bodies, in sensations and images. When our clients try to talk about their hardest experiences, language often fails them, creating barriers to treatment. This isn’t resistance; trauma is stored in our bodies. Creative approaches offer another way to help our clients process their experiences and regulate their nervous systems.
Art and movement can create a safe distance from difficult experiences. Drawing a feeling on paper or shaping it in clay allows clients to look at it, change it, or set it down. They can step away from the experience and move at a pace that works for them.
Creative approaches restore choice, which trauma so often takes away. Clients can learn to regulate their nervous systems through rhythm and breath. These approaches can also bring back play and curiosity, which are important ways we relearn safety.
For clinicians who feel this is outside their usual scope of practice, focus on the process, not the product. Simply inviting a client to draw, move, stomp, dance, or even scream, rather than explain their experience, can open doors that talking alone may not have opened.
Bring These Approaches Into Your Practice
Interested in bringing these approaches into your clinical practice? Join Lisa Maestri for an upcoming workshop exploring how to incorporate somatic and expressive modalities into trauma-informed care and expand your therapeutic toolbox.
Incorporating Somatic and Expressive Modalities in a Trauma Informed Lens
Tuesday, October 20
In-Person at the Hilton Garden Inn, Owings Mills, MD
Earn 6 CEUs
Lisa Maestri is a licensed clinical social worker in Maryland and Virginia who specializes in complex trauma, eating disorders, and addictions. A graduate of The Ferentz Institute’s Level I and Level II Certificate Programs in Advanced Trauma Treatment, Lisa integrates somatic approaches, mindfulness, movement, and expressive arts into her clinical practice to help clients regulate their nervous systems and support healing.