Atlas›Domain IV · Body-oriented psychotherapy›Guide 109
Guide IV-109

Self Regulation Therapy

Lynne Zettl, Edward Josephs2001Vancouver, Canada
A 29 · L 39 · M 3221 interventions in the Trinity explorer
Client cardCompare
[source: …] where a claim comes from[uncertain] not confirmed in a primary source[synthesis] the writer's reconstruction

1. Introduction

Version followed: Self Regulation Therapy (SRT) as taught by the Canadian Foundation for Trauma Research & Education (CFTRE), developed by Dr. Lynne Zettl and Dr. Edward (Ed) Josephs. CFTRE's own training manuals are not public, so this guide pieces the method together from three sources: Zettl's 2004 interview; a summary by psychologist Susan LaCombe of Josephs and Zettl's lecture series "Trauma and the Triune Brain" (2000–2001) and the SRT advanced modules (2001); and a 2014 University of Alberta thesis by Stalenhoef that draws on CFTRE training and on a personal conversation with Zettl. Where SRT material is thin, procedures from its parent method, Peter Levine's Somatic Experiencing (SE), are added and marked [SE-derived]. [source: Lepage/Zettl 2004; LaCombe; Stalenhoef 2014]

Name check. The founders are Edward Josephs, a clinical neuropsychologist, and Lynne Zettl, a clinical psychologist in Vancouver. Do not confuse SRT with two unrelated methods that share the initials: "Soft-Stretch Release Techniques", a fascial bodywork method, and Reggie Melrose's "Self-Regulation Training". [source: Lepage/Zettl 2004; Stalenhoef 2014]

What it is. Zettl describes SRT as a "non-cathartic mind/body approach aimed at diminishing excess activation in the nervous system". [source: Lepage/Zettl 2004; CCPA article] It grew out of the founders' training in Somatic Experiencing. Zettl had also spent about twelve years combining SE with Bodynamics and CranioSacral Therapy. [source: Lepage/Zettl 2004; LaCombe; Stalenhoef 2014] Zettl's 1998 doctoral study applied SE with 14 emergency-service workers. Stalenhoef dates SRT's development to around 2001. [source: Stalenhoef 2014; [uncertain]] CFTRE teaches two streams:

  • SRT Practitioner training, for shock trauma.
  • Psychological Anatomy, for developmental dysregulation.

[source: Stalenhoef 2014]

How change happens, in the school's own terms. SRT holds that overwhelming events leave the autonomic nervous system dysregulated, and that the problem is "in the nervous system and not in the event". [source: Stalenhoef 2014, attributing this to CFTRE teaching] The dysregulation is held as procedural, body-based memory in lower brain structures, which talk alone is said not to reach. [source: LaCombe] The therapist does three things:

  • Keeps the client inside a tolerable range of activation.
  • Builds resources.
  • Lets the client meet traumatic activation in very small doses while tracking body sensation.

In this way, interrupted fight, flight or freeze responses can complete and excess activation can discharge, gradually and without catharsis. This is said to build new neural pathways for handling stress. [source: Lepage/Zettl 2004; LaCombe; Stalenhoef 2014] SRT borrows the kindling and quenching model from animal research by Post and colleagues: low-level, resourced stimulation is said to reverse kindled threat responses. Clinicians should treat this as the school's theory, not as established physiology. [source: LaCombe; Stalenhoef 2014] [uncertain: neurobiological claims are unverified]

Scope cautions. Some promotional sources list physical conditions such as chronic pain, migraine, fibromyalgia, GI problems, asthma and allergies. SRT is not a treatment for physical disease. Use it for trauma-related dysregulation alongside normal medical care. [source: Lepage/Zettl 2004; Roy Psychotherapy; LaCombe notes that clinical trials of SRT "have yet to be completed"] [synthesis]

2. Framework

The sources found do not give a formal phase model for SRT. The sequence below follows LaCombe's ordering of the work: resources, then tracking, then titrated exposure, then defensive impulses, then consolidation and meaning, then self-soothing. It adds Zettl's goal-setting step at the start. [source: LaCombe; Lepage/Zettl 2004; phase labels and transition criteria are [synthesis]]

Format. Individual sessions with the client seated and talking. The work runs through attention to sensation, imagery and small movement, not through manual technique (see touch note in 4.20). Zettl gives no fixed number of sessions. She says clients typically "begin to feel better after a few sessions" and that treatment is usually much shorter than conventional therapy. Shock-trauma work is often brief. Developmental dysregulation (the Psychological Anatomy stream) is expected to take longer, but no figures were found. [source: Lepage/Zettl 2004; Stalenhoef 2014] [uncertain] The usual 50–60-minute session length is an assumption. [synthesis]

Phase A. Assessment and goals

  • Goals: agree short- and long-term goals so progress can be judged and an endpoint set. [source: Lepage/Zettl 2004]
  • Map the client's pattern of dysregulation. Sympathetic over-activation shows as hypervigilance, startle, panic, rage and insomnia. Parasympathetic over-activation shows as depression, numbness, exhaustion and alexithymia. Many clients alternate between the two. [source: CCPA article, reporting CFTRE training]
  • Explain discharge and possible after-effects (see 4.2).
  • Screen for risk and contraindications. [synthesis]
  • Move on when: goals are agreed, the client understands the non-cathartic, small-dose approach, and risk is managed. [synthesis]

Phase B. Resourcing and stabilisation

  • Goals: give the client internal, external and body resources they can actually feel in the body, and teach tracking. [source: LaCombe; Stalenhoef 2014]
  • Move on when: the client can find a resource and feel it physically, can report sensations, and settles back within the session after a small rise in activation. [synthesis]

Phase C. Titrated renegotiation of activation

  • Goals: approach trauma-linked activation in very small amounts and alternate with resource. Allow discharge and support defensive impulses to complete, physically or in imagination. [source: LaCombe; Stalenhoef 2014]
  • Body-centred processing comes first. Cognitive and emotional exploration of the trauma is held back until a stable baseline exists, because LaCombe warns that premature cognitive exploration risks misattribution and false memories. [source: LaCombe]
  • Each session should end with the client settled and with a sense of control. [source: Lepage/Zettl 2004]
  • Move on when: trauma cues produce less activation, there is less flooding or shutdown between sessions, and the client recovers faster after spikes. [synthesis]

Phase D. Consolidation, meaning and self-regulation

  • Goals: make meaning only after activation has resolved, then consolidate self-soothing and self-control in daily life. [source: LaCombe]
  • End treatment against the goals agreed in Phase A. [source: Lepage/Zettl 2004]

Developmental stream (Psychological Anatomy). CFTRE teaches this as a separate course on developmental dysregulation. Its procedures were not found in any source opened, and this guide does not reconstruct them. [uncertain]

Training. As of 2012–2014, certification required Foundational Levels I–IV and Advanced Levels I–IV. The advanced level ran as eight three-day seminars, and trainees also completed 20 hours of personal therapy and 20 hours of supervision. Current requirements may differ. [source: Stalenhoef 2014] [uncertain]

3. Guiding principles

  • Non-cathartic. The aim is to lower activation, not release it dramatically. Practical meaning: never push for crying out, hitting or reliving; if catharsis starts, slow down. [source: Lepage/Zettl 2004; Conscious Completion]
  • The trauma is in the nervous system, not the event. Work with the activation the story stirs up, not the details of the story. [source: Stalenhoef 2014]
  • Stay within the range of tolerable activation. Check the client's state constantly and keep arousal where they can still feel it and report it. [source: LaCombe; Roy Psychotherapy]
  • Titrate: small amounts. A practitioner page calls these "homeopathic" doses. Touch one small piece of activation, then pause. [source: Roy Psychotherapy; LaCombe]
  • Reintegration, not reliving. LaCombe's phrase is "reintegration—not a reliving". If a flashback occurs, read it as a sign you went too fast. [source: LaCombe]
  • Resource before and during activation. Never open trauma material until a felt resource is available. Go back to it whenever activation climbs. [source: LaCombe; Stalenhoef 2014]
  • Body first, meaning later. Hold off interpretation and memory reconstruction until the body has settled. [source: LaCombe]
  • Track, don't interpret. Ask what the client notices in the body, and name what you observe, such as breath, colour and stillness. [source: LaCombe]
  • Completion of thwarted defences. Watch for and support small urges to push, turn or flee. [source: LaCombe; Lepage/Zettl 2004]
  • Imagination over gross movement. Let the client complete defensive impulses in imagination or in small, slow movements. Imagination is said to titrate activation and allow discharge. [source: Stalenhoef 2014, citing Zettl 2014]
  • Allow discharge, don't block or amplify it. Normalise heat, tingling, trembling, tears or laughter and let them pass. [source: Lepage/Zettl 2004; Stalenhoef 2014; Roy Psychotherapy]
  • The therapist's own regulation is an intervention. Stalenhoef describes right-brain-to-right-brain attunement, citing Schore. Keep your own breath and voice settled; the client co-regulates with you. [source: Stalenhoef 2014]
  • Safe, contained environment. Predictable structure, client control over pace, and an end point agreed for each session. [source: Lepage/Zettl 2004]
  • Client control. The client should leave sessions with a greater sense of control, so offer choices and stop when asked. [source: Lepage/Zettl 2004; Conscious Completion]
  • Goal-anchored and time-limited. Review progress against the agreed goals. [source: Lepage/Zettl 2004]

4. Intervention inventory

This inventory lists every SRT procedure named in the sources. Where those sources name a procedure but give no steps, the steps come either from the parent method, marked [SE-derived] (Payne, Levine & Crane-Godreau 2015), or from the author of this guide, marked [synthesis]. All example therapist language is illustrative wording, not CFTRE scripts.

4.1 Goal setting and dysregulation mapping

  • Purpose: Set an endpoint and identify the client's main autonomic pattern, so you know whether to work mainly with high arousal or with shutdown. Use it at intake and at reviews. [source: Lepage/Zettl 2004; CCPA article]
  • Steps:
    1. Ask for short-term and long-term goals and turn each into something observable, such as sleeping through, driving past the site, or not freezing in arguments.
    2. Ask about sympathetic-type symptoms: startle, hypervigilance, panic, rage, insomnia.
    3. Ask about parasympathetic-type symptoms: numbness, collapse, exhaustion, feeling far away, difficulty naming feelings.
    4. Ask whether the client alternates between the two.
    5. Note whether the presentation is a single shock event or long-standing developmental dysregulation. CFTRE teaches these in separate streams.
    6. Record baseline ratings. [synthesis for step 6]
  • Example language (illustrative): "When you're stressed, does your system tend to rev up — heart racing, on guard — or go flat and far away? Or both?"
  • Watch for: Clients with mostly shutdown or dissociative patterns need slower pacing and more resourcing (see 4.14). [synthesis]

4.2 Psychoeducation and informed consent about effects

  • Purpose: Prepare the client for the body-based, small-dose method and for normal reactions to it.
  • Steps:
    1. Explain the school's model: the nervous system got stuck in a survival response, and you will help it settle a little at a time, without reliving the event.
    2. Explain that during or after sessions the client may feel heat, tingling or trembling. Pain may briefly increase, sensory experience may intensify, and activation can rise for a while before it settles. Zettl calls pain flare-ups "typically short-lived".
    3. Agree that the client controls the pace and can stop at any time.
    4. Say plainly that the method's explanations are a working model, and that the method does not replace medical care. [synthesis for step 4]
    [source: Lepage/Zettl 2004; Roy Psychotherapy; LaCombe]
  • Example language (illustrative): "We'll go much more slowly than you might expect. If you notice warmth, tingling or a little shaking, that's usually the body settling. You can tell me to pause at any point."
  • Watch for: Clients who expect a dramatic breakthrough. Re-explain the non-cathartic aim.

4.3 Safe, contained setting and therapist self-regulation

  • Purpose: Give the client a regulated presence to co-regulate with. Zettl describes the therapist as providing a "safe, contained environment". [source: Lepage/Zettl 2004; Stalenhoef 2014 on right-brain attunement]
  • Steps:
    1. Offer the client a choice of seat and distance. [SE-derived: the Payne et al. case begins with a choice of chair]
    2. Before and during the session, notice your own breath, posture and tension, and settle them.
    3. Speak slowly and warmly, and keep your face responsive.
    4. Keep the session predictable: open, do the work, and close with the client settled. [synthesis for steps 2–4]
  • Watch for: Your own activation rising alongside the client's. Slow your breath before you intervene. Stalenhoef reports that CFTRE treats the therapist's regulation as essential.

4.4 Resourcing

  • Purpose: Build anything that "somatically resonates in a positive way" so it can stabilise and widen the client's tolerance before and during trauma work. Use it from the first session and whenever activation climbs. [source: LaCombe]
  • Resource types: [source: Stalenhoef 2014; LaCombe]
    • External: supportive people, places in nature, animals, art, rituals.
    • Internal: imagination, humour, positive memories, strengths, passions.
    • Body: places in the body that feel neutral or good, which LaCombe says can give immediate stabilisation.
  • Steps:
    1. Ask for something or someone that helps the client feel even slightly better or safer.
    2. Ask for sensory detail: what they see, hear, and the temperature or texture.
    3. Ask where in the body they notice something as they hold the resource. A resource only counts once it is felt in the body. [source: LaCombe; Payne et al. 2015]
    4. Ask about the quality of the sensation (warm, open, heavier, steadier) and let the client stay with it for a while.
    5. Ask whether a similar feeling appears anywhere else in the body. [SE-derived]
    6. Name the resource so you can return to it later.
  • Example language (illustrative): "As you picture the lake, what happens in your body? … Where is that warmth? … Take a moment just to let it be there."
  • Watch for: A "resource" that triggers grief or longing, such as a deceased parent; choose another. A resource the client can only think about but not feel; slow down and look for a body resource such as feet on the floor. Signs it is working: slower breath, softer shoulders, warmer colour, spontaneous sighing. [source: LaCombe; synthesis for the signs list]

4.5 Tracking sensation (felt sense)

  • Purpose: Build the client's awareness of their own arousal and release signals, which is the main channel of the method. [source: LaCombe; Roy Psychotherapy; Stalenhoef 2014 citing Gendlin]
  • Steps:
    1. Invite attention inward to sensations as they arise: breathing, heartbeat, temperature, muscle tension, involuntary movement, and the overall "felt sense" (Gendlin's term).
    2. Ask for description rather than explanation: location, size, quality, movement.
    3. Follow changes moment by moment, without trying to fix anything.
    4. If a sensation becomes too strong, move to a resource (4.4) or to the periphery of the sensation. [synthesis for step 4]
  • Example language (illustrative): "What do you notice right now? … Is it more on the left or the right? … And as you stay with it, does it stay the same or change?"
  • Watch for: Analysing or storytelling in place of sensing; gently bring attention back to the body. "I feel nothing" may mean shutdown (see 4.14).

4.6 Therapist observation of autonomic signs

  • Purpose: Read state from the outside as well as from what the client says. [source: LaCombe]
  • Steps:
    1. Watch for sympathetic signs: faster or higher breathing, pallor, widened eyes, restlessness, tightening.
    2. Watch for parasympathetic shutdown: flat voice, slumping, glazed look, slowed responses.
    3. Watch for settling signs: deeper breath, sighing, colour returning, softening.
    4. Check what you see against what the client reports, and name observations tentatively. [synthesis for the detailed sign lists and step 4]
  • Example language (illustrative): "I notice your breathing just got a little quicker — what are you aware of?"

4.7 SIBAM exploration (SRT variant)

  • Purpose: Explore experience through all of its channels. Levine's SIBAM model covers Sensation, Image, Behaviour, Affect and Meaning; SRT renames the "Image" channel "Impression". [source: Stalenhoef 2014] Detailed SRT steps were not found. [uncertain]
  • Steps:
    1. Notice which channel the client is in, for example story (meaning) without sensation, or emotion without body.
    2. Invite a neighbouring channel to round the experience out.
    3. Keep Meaning for later phases. [synthesis]
  • Example language (illustrative): "Along with that sadness, what do you notice physically?"

4.8 Titration

  • Purpose: Expose the client to "minute" amounts of activation so the event can be reintegrated without being relived. [source: LaCombe; Roy Psychotherapy; Stalenhoef 2014]
  • Steps:
    1. Start from a felt resource.
    2. Bring in only a peripheral, low-charge fragment of the event, such as the hours before it, a neutral sensory detail, or the edge of a sensation. [SE-derived: Payne et al. case starts from the morning of the accident]
    3. Track what rises for a few breaths.
    4. Stop or go back to the resource well before the activation peaks.
    5. Let it settle fully, then take the next small piece.
    6. Use imagination, such as imagined scenes or actions, as the main way to approach material. Stalenhoef, citing Zettl, reports that imagination titrates activation and allows discharge.
  • Example language (illustrative): "Just touch the very beginning of that morning — nothing more — and notice what happens inside. … OK, let's come back to your feet on the floor."
  • Watch for: Flashbacks, flooding, or a sudden drop into numbness. LaCombe treats a flashback as a sign that activation rose too fast; reduce the dose. Signs it is working: activation rises and falls within the session, and the next exposure produces less. [source: LaCombe; synthesis]
  • Exposure safety: Agree a stop signal, keep the doses small, and do not start titration with clients who are acutely suicidal, psychotic, severely dissociative or in ongoing danger until they are stabilised. [synthesis]

4.9 Alternating activation and resource

  • Purpose: LaCombe defines titration as gradual alternation between small amounts of trauma material and resourced states. SE calls this rhythm "pendulation". [source: LaCombe; SE-derived: Payne et al. 2015] The term "pendulation" was not found in the SRT sources. [uncertain]
  • Steps:
    1. After each small activation (4.8), deliberately shift attention to the resource or a comfortable body area.
    2. Stay there until the system settles.
    3. Return to the activation edge.
    4. Repeat several times per session.
  • Example language (illustrative): "Notice the tightness in your chest … and now let your attention go to the warmth in your hands. … Stay there. … When you're ready, check the chest again."
  • Watch for: The client gets stuck in either pole. Being stuck in activation means flooding; being stuck in the resource means avoidance. Help them move between the two. [synthesis]

4.10 Allowing discharge

  • Purpose: Let the bound activation release naturally. Signs of discharge include heat, tingling, trembling or shaking, twitching, tears, laughter, sighing and yawning. [source: Lepage/Zettl 2004; Stalenhoef 2014; Conscious Completion; SE-derived for sighing and yawning]
  • Steps:
    1. When a discharge sign appears, name it calmly and normalise it.
    2. Ask the client to just notice it and let it move as much as it wants, without pushing or holding back.
    3. Track it until it subsides.
    4. Check for settling afterwards: breath, warmth, a sense of ease.
  • Example language (illustrative): "That trembling is fine — just let it happen at its own pace. … And now that it's easing, what do you notice?"
  • Watch for: Discharge that escalates into sobbing, panic or catharsis. That is beyond titration; slow down with 4.11 or orienting (4.15). Practitioner sources say discharge should not be blocked, but also that release in a catharsis is not the goal. [source: Roy Psychotherapy; Conscious Completion]

4.11 Imagery to modulate discharge and activation

  • Purpose: Give the client a sense of control over how fast activation moves. Stalenhoef reports SRT's use of a "dimmer switch", a volume control, or a pressure-cooker valve, and of letting tension dissipate "one molecule at a time". [source: Stalenhoef 2014]
  • Steps:
    1. When activation or discharge feels like too much, offer an image of control. Let the client choose or adapt it.
    2. Ask the client to imagine turning the intensity down a notch, or letting just a little steam out of the valve.
    3. Track what changes in the body.
    4. Keep the image as a named tool for later sessions and for use at home. [synthesis for steps 3–4]
  • Example language (illustrative): "If this feeling had a dimmer switch, could you turn it down just a little? … What happens when you do?" or "Let it leave one molecule at a time." (The second phrase is the image as Stalenhoef reports it.)
  • Watch for: Images that the client experiences as suppression ("shut it off"). The aim is graded release, not shutting down. [synthesis]

4.12 Supporting defensive impulses: completing thwarted fight, flight or freeze responses

  • Purpose: As immobility loosens, clients may feel urges to push, twist or flee. Allowing these urges, either physically or in imagination, is said to lower autonomic activation and complete the interrupted response. [source: LaCombe; Lepage/Zettl 2004; Stalenhoef 2014]
  • Steps:
    1. While titrating (4.8), watch for micro-movements and ask about urges in the hands, arms, legs or neck.
    2. When an urge is present, ask the client to notice it first, before acting on it.
    3. Invite them to let it happen very slowly, either in imagination (SRT prefers this to gross movement) or as a small, slow physical movement, such as hands pressing gently forward or legs feeling the readiness to run. [source: Stalenhoef 2014; SE-derived: Payne et al. 2015 describe slow-motion completion of a turning gesture]
    4. Track the sensations during and after the movement, especially strength, warmth and relief.
    5. Return to the resource and let it settle.
  • Example language (illustrative): "Your hands look like they want to do something. … Without doing it yet, what do they want? … Let that push happen really slowly, maybe just in your imagination at first, and feel the strength in your arms."
  • Watch for: Speed or force. Fast, large movement turns into catharsis, so slow it down. Signs it is working: reports of strength, relief, lightness, or a deeper breath afterwards. For physical movement, check first for injury, pain or medical limits, and use imagination only where movement is unsafe. Do not use hitting or kicking. [synthesis for contraindication screening]

4.13 Working with freeze and immobility

  • Purpose: LaCombe calls the immobility response a key factor in trauma, and SRT aims to help the frozen or "stuck" state shift towards movement and warmth. [source: LaCombe]
  • Steps:
    1. Name the freeze gently and normalise it as a protective response.
    2. Start with the smallest available sign of life: a finger moving, the breath, a warm spot.
    3. Track that sign slowly.
    4. Let defensive impulses (4.12) emerge only when they come on their own.
    5. Alternate with the resource.
    6. Expect cold-to-warm shifts and trembling as the freeze lets go. [source: LaCombe for cold-to-warm and stuck-to-movement shifts; steps are [synthesis]]
  • Example language (illustrative): "It makes sense your body went still — that protected you. Is there any small part that can move even a little right now?"
  • Watch for: Freeze tipping into collapse or dissociation (see 4.14).

4.14 Working with dissociation

  • Purpose: Bring the client back into felt awareness without overwhelming them. SRT distinguishes two styles of dissociation:
    • A gradual narrowing or dimming of awareness, like a dimmer switch.
    • A sense of being outside the body.
    Work slowly, and restore awareness through resources that are already established. [source: Stalenhoef 2014]
  • Steps:
    1. Notice which style is present: fading and dimming, or being out of the body.
    2. Stop adding activation.
    3. Bring in an established resource and simple present-moment sensory contact (4.15).
    4. Invite awareness back in small steps, for example "Can you feel your hands?" before "Can you feel your chest?"
    5. Resume titration only when presence is reliable. [synthesis for steps 2–5]
  • Example language (illustrative): "It seems like things got a bit far away. Let's slow right down. Can you feel the weight of your feet? … What can you see in the room?"
  • Watch for: Severe or structural dissociation, for example a dissociative identity disorder (DID) or OSDD presentation, needs a phase-oriented stabilisation approach and specialist supervision before SRT-style trauma work. [synthesis]

4.15 Orienting to the present and interrupting overwhelm [SE-derived]

  • Purpose: Bring a client back from flooding or re-entry into the memory. The SRT sources list restored "defensive orienting" and a sense of safety as outcomes, but the orienting procedure below comes from the SE case material. [source: LaCombe; SE-derived: Payne et al. 2015] [uncertain: exact SRT procedure not found]
  • Steps:
    1. Use a firm, warm voice and the client's name.
    2. Ask them to open their eyes if closed.
    3. Invite them to look around slowly and name a few things they see.
    4. Ask them to feel the chair and the floor.
    5. Track their breath until it slows.
    6. Move to the resource.
    7. Afterwards, make the next dose smaller.
  • Example language (illustrative): "Maria, come back to the room with me. Open your eyes. … Tell me three things you can see. … Feel the chair holding you."
  • Watch for: Breath slowing and eye contact returning show it is working. If orienting does not settle the client, extend the stabilisation and review risk (Section 5).

4.16 Boundaries and boundary ruptures

  • Purpose: SRT is said to help restore healthy boundaries, and CFTRE teaching refers to work with "boundary ruptures". [source: LaCombe; Stalenhoef 2014 chapter heading] No SRT procedure for boundary work was found in the sources. Stalenhoef links imagined action to the sense of peripersonal space and "personal containment and protection", but as her own proposal. [uncertain] SRT's boundary teaching may draw on Bodynamics, which Zettl integrated, but this was not verified. [uncertain]
  • Steps: No SRT steps are given in the sources. A cautious application consistent with the principles above follows. [synthesis]
    1. Ask the client to notice how close is comfortable, for example between them and you or around their chair.
    2. Invite them to imagine a boundary at that distance and track the sensations.
    3. Where an impulse to protect arises, support it as in 4.12.
  • Example language (illustrative): "Notice how much space feels right around you right now. … What happens in your body when you imagine that space is respected?"
  • Watch for: Ruptures within the therapy relationship itself (Section 5).

4.17 Consolidation and meaning-making

  • Purpose: Integrate the event cognitively and emotionally once activation has resolved. LaCombe places meaning-making after somatic resolution, and Stalenhoef describes a shift in the felt sense as reducing the event's hold. [source: LaCombe; Stalenhoef 2014]
  • Steps:
    1. After a cycle has settled, invite the client to notice what is different now in the body, and then in how they see the event or themselves.
    2. Let the meaning come from the client.
    3. Link changes to the agreed goals. [synthesis for the step detail]
  • Example language (illustrative): "Now that your body has settled, when you think of that day, what's different?"
  • Watch for: Interpretation imposed early. LaCombe warns that premature cognitive exploration risks misattribution and false memories, so do not suggest memories or causes.

4.18 Building self-soothing and between-session practice

  • Purpose: Over time, the client should be able to modulate their own responses and self-soothe. [source: LaCombe; Roy Psychotherapy] The sources do not describe set homework. [uncertain]
  • Steps (suggested practice; not from SRT sources): [synthesis]
    1. Agree one or two brief practices from the session, for example recalling the resource and feeling it in the body, a short tracking check-in, or the dimmer image.
    2. Ask the client to use them briefly when they notice early signs of activation.
    3. Review what happened at the next session.
  • Example language (illustrative): "This week, when you notice your chest tightening, try a minute with the lake image and see what your body does."

4.19 Closing a session

  • Purpose: Zettl expects clients to leave with a sense of control and well-being. [source: Lepage/Zettl 2004]
  • Steps: [synthesis]
    1. Stop opening new material roughly 10–15 minutes before the end.
    2. Return to the resource and orient to the room.
    3. Check the client's state and arousal.
    4. Remind them of possible after-effects (4.2) and how to contact you.
    5. Do not end while the client is activated or shut down.

4.20 Touch: not part of SRT as documented

  • None of the SRT sources describes touch as an SRT technique. They describe work with attention, sensation, imagination and small movement. Zettl separately integrated CranioSacral Therapy, and some practitioners combine SRT with CranioSacral or visceral manipulation, but these are separate methods. [source: Lepage/Zettl 2004] [uncertain]
  • If a clinician who is trained in a touch-based adjunct adds touch, it requires several things. [synthesis]
    • Specific training, supervision, and a check of what the clinician's licence and jurisdiction allow.
    • An explanation before any touch, explicit permission, and a no-touch alternative offered and respected.
    • An agreed stop signal, check-ins during and after, and documentation.
    • Touch only on non-intimate areas, such as hands, forearms, shoulders or upper back, and never sexual or genital touch.

4.21 Integration with expressive art (derived application)

  • Stalenhoef (2014) proposed combining SRT with art therapy, for example tracking the felt sense while making or viewing images, and using imagination as a resource. This is her proposal, not CFTRE protocol. She also notes Malchiodi's caution that trauma imagery can trigger strong fear responses. Titrate image-making the same way as any exposure. [source: Stalenhoef 2014] [synthesis]

5. Handling problems

The SRT sources say little about problem management. Except for the source-tagged points, the guidance below is [synthesis] built from the SRT principles in Section 3.

Screening and contraindications

  • Hold or adapt trauma titration (4.8–4.13) until stabilised or specialist care is in place for clients with any of these: active suicidality or recent self-harm, psychosis or mania, severe or structural dissociation, ongoing danger such as current abuse, unmanaged substance withdrawal, or recent trauma where the person is still unsafe. [synthesis]
  • Physical movement work (4.12):
    • Screen for recent injury or surgery, pain conditions, pregnancy, cardiovascular, respiratory or seizure conditions.
    • Keep movement small and slow, or work in imagination only.
    • SRT is non-cathartic: do not use hitting, kicking, screaming or breath intensification.
    [synthesis; SRT's non-cathartic stance from Lepage/Zettl 2004]
  • Suicide risk: If suicidal thoughts emerge, carry out a standard risk assessment and safety planning, including lethal-means counselling about safe storage and removal. Pause titration until the risk is managed. [synthesis]

Overwhelm, flooding and flashbacks in session

  • LaCombe reads a flashback as activation that rose too fast. [source: LaCombe]
  • Respond in this order:
    1. Stop the content.
    2. Orient (4.15).
    3. Bring in the resource (4.4) and the dimmer image (4.11).
    4. Do not resume until breath and eye contact are back.
  • In the next session, start with a smaller dose and from a more peripheral fragment. [synthesis]

Increased symptoms after sessions

  • Expected short-term effects include temporary pain flare-ups, more intense sensory experience and a temporary rise in activation, which Zettl describes as "typically short-lived". [source: Lepage/Zettl 2004; Roy Psychotherapy]
  • Response:
    1. Normalise it, and agree a check-in plan.
    2. Reduce the dose and lengthen resourcing next time.
    3. If the deterioration persists or is severe, such as sleep loss, rising suicidality or functional collapse, stop trauma work, reassess and consider referral. [synthesis]

"I don't feel anything" / poor interoception

  • Treat numbness as possible parasympathetic shutdown, not resistance. [source: CCPA article on PNS over-activation]
  • Start from the outside in:
    • Contact with the chair and floor, temperature, and what the client sees.
    • Neutral body areas.
    • Very short tracking intervals, with your own observations offered tentatively (4.6).
    [synthesis]

Stuck: no change across sessions

  • Check whether the client is avoiding the activation edge (stuck in the resource), flooding (dose too big), or intellectualising (channel stuck in Meaning; use 4.7).
  • Check whether the presentation is actually developmental rather than shock trauma. That would call for CFTRE's Psychological Anatomy stream or another developmental approach, which this guide does not cover. [source: Stalenhoef 2014 on the two streams; synthesis]
  • Review the goals (4.1). If there is no progress after an agreed review period, consider an evidence-based trauma-focused therapy and refer. [synthesis]

Client pushing for catharsis or the full story

  • Explain the non-cathartic rationale again, and the risk of reliving rather than reintegrating. [source: LaCombe; Lepage/Zettl 2004]
  • Acknowledge the wish to "get it out", and offer to come to the story in small pieces.
  • Agree together how far to go in the session. [synthesis]

Non-adherence to between-session practice

  • Practices are not specified by the sources. Keep them minimal (one per week), link them to the client's goals, and debrief without judgement. [synthesis]

Ruptures and boundary issues in the relationship

  • Signs include the client withdrawing, appeasing you, or freezing in response to your intervention.
  • Response:
    1. Stop and name it tentatively.
    2. Ask what the client noticed and what they need, for example more distance, less focus on the body, or a different pace.
    3. Take responsibility for pacing errors.
    4. Give back control over pace and over what is explored. [synthesis; SRT names boundary-rupture work but procedure not found, [uncertain]]
  • Watch for compliance: clients with freeze or appease patterns may say "fine" while shutting down. Read the body cues (4.6). [synthesis]

Memory and suggestion risks

  • Do not suggest events, perpetrators or "body memories" of unremembered abuse. Keep meaning-making client-led and late. LaCombe warns that premature cognitive exploration can produce misattribution and false memories. [source: LaCombe]

Scope, claims and modality-specific cautions

  • Do not present SRT as treating physical illness. Promotional sources list many medical conditions without outcome data. Coordinate with medical care for somatic symptoms. [source: Lepage/Zettl 2004; Roy Psychotherapy; synthesis]
  • Present the neurobiological explanations (triune brain, kindling and quenching, "discharge of energy") as the school's model. [synthesis]
  • Some practitioners add transgenerational "clearing", "energetic boundaries" or devices. These are not SRT as documented by CFTRE. [source: Conscious Completion]
  • Practise SRT only after CFTRE or equivalent training and with supervision. [source: Stalenhoef 2014 on certification; synthesis]

Sources

Sources

Further reading (not drawn on) [uncertain]

  • Josephs, E., & Zettl, L. (2000–2001). Trauma and the Triune Brain lecture series; Self-Regulation Therapy advanced training modules (2001). CFTRE, unpublished training materials.
  • Zettl, L. (1998). Doctoral dissertation on Somatic Experiencing with emergency service workers.
  • Levine, P. A. (1997). Waking the Tiger: Healing Trauma. North Atlantic Books.
  • Levine, P. A. (2010). In an Unspoken Voice. North Atlantic Books.
  • Gendlin, E. T. (1978). Focusing. Everest House.
  • Post, R. M., et al. (1997). Work on kindling and quenching (as cited by Stalenhoef and LaCombe).
  • Schore, A. N. (2012). The Science of the Art of Psychotherapy. Norton.
  • Porges, S. W. (2011). The Polyvagal Theory. Norton.
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