The Somatic Legacy of Complex Trauma

People who experienced complex post-traumatic stress disorder (C-PTSD) or ongoing ‘complex’ childhood trauma consisting of neglect, abuse, and invalidation, develop strategies and defenses designed to make sense of the painful truth that their caregivers failed to provide essential emotional and physical attachment needs. These protective strategies, though geared for survival, become obstacles to overall health, self-expression, healthy relationships, and fulfilling careers. Clients who endured abuse or invalidation during childhood developed exquisite sensitivity to external cues that helped them manage chaotic or unpredictable environments. This hyper-attunement to external inputs, a kind of hypervigilant codependence, evolved while clients were simultaneously repressing internal cues like hunger, thirst, fatigue, toileting, and comfort as a result of needs repeatedly going unmet. It becomes a survival strategy to not feel or acknowledge them. By having suppressed their basic physical needs, these clients experience ongoing internal tension expressed as anxiety and depression, dysregulation, and codependent behaviors.

Growing up surrounded by reactive adults who did not provide functional emotional modeling, clients’ emotional tools are restricted. They became over-focused on external sources of validation which contribute to ongoing anxiety and reactivity. This situation fundamentally disrupts clients’ capacity for implementing self-care and other functional behaviors necessary for a healthy life.

Developing in an unsafe environment, clients’ ongoing somatic experience is of underlying danger and unpredictability. With porous boundaries and distorted perceptions, they look for confirmation of this bias in every interaction, are poised to identify danger, and experience unbearable flooding. This frequently leads to hypersensitivity to criticism and rejection along with perfectionistic tendencies as a defense against chaos.

In multiple cases, I have found that encouraging these clients to pay attention to and satisfy cues like hunger, thirst, physical discomfort, and toilet needs as a primary intervention is transformational. Providing a supportive container to address their needs evokes a crucial new experience in which to foster change.

In session, I routinely encourage clients to make themselves physically comfortable, whether we meet online or in person. My office has yoga mats, pillows, a physioball, chairs, and a long sturdy Pilates table. Throughout sessions, I cue them to check in with their sensations using direct questions with non-threatening words like, “what’s coming up for you now,” “are you still comfortable or do you need to move,” “feel free to adjust, move, or make yourself more comfortable,” “what would feel safer in this moment?” My aim is to highlight internal sensations and give explicit permission to foreground their physical needs over anything else—something that their upbringing did not allow or was not safe for them to do.

Because breathing is foundational to life, breathwork can also be a powerful tool for addressing dysregulation, though it requires careful implementation with Complex PTSD clients. Some clients may find breath-focused exercises triggering due to their trauma—for instance, one of my transgender clients rejected breathwork entirely due to traumatic experiences in a religious cult.

I begin with gentle, non-invasive approaches like observing the difference between nose and mouth breathing to help regulate anxiety. From there, I guide clients to simply notice physical sensations: the feel of air moving through their nostrils, the natural expansion and release of their lungs and abdomen. To demonstrate healthy breathing mechanics, I use a Hoberman Sphere to illustrate what I call "three-dimensional breathing"—showing how the thorax can move in all directions: length, width, and depth.

While advanced breathing techniques like those used in Kriya Yoga can create profound physiological and psychological changes through specific patterns of inhalation, exhalation, and breath retention, my primary goal with CPTSD clients is more fundamental. Simply helping them feel safe enough to take full, unrestricted breaths often begins to release long-held patterns of physical tension and armoring.

Attending to the Body in Therapy

A 23-year-old man in graduate school was recently diagnosed with bipolar disorder and had a history of physical abuse. In session he would frequently jiggle his leg. I noticed this becoming more intense when we discussed an upcoming exam. I used immediacy to bring his attention to his movement and invited him to tune into what his leg might be saying. He expressed anxiety and wanting to flee. I said, “feel free to run out of the room. I will be right here waiting for you whenever you are ready to return.”

Though surprised, he got up and left the room. A few minutes later, he came back, grinning. That completed escape and safe reception upon his return was a lynchpin to his future empowerment and ability to connect with his deepest desires. Further work around hunger ignited a passion for cooking that helped him solidify connections with friends.

During a session with a 19-year-old non-binary client, they revealed that at work they were so overburdened they didn’t urinate for up to 8 hours. When I expressed surprise and concern, they reported their boss often neglected to allow breaks. Not only due to the questionable legality of this situation, but due to this client’s habitual self-neglect, I encouraged them to insist on being allowed to take care of their bathroom needs.

In case clients don’t feel empowered to stand up for their needs, I encourage them to blame it on me, their therapist. In this way, therapy helps them repair personal boundaries caregivers often neglected to help them build. Over the course of our ensuing sessions, this client reported on the transformation they experienced because of this new awareness. Not only were they able to stand up for themselves in other interpersonal situations, they went on to become stronger advocates for animal welfare.

A 45-year-old woman was seeking therapy for chronic illness and overwhelming guilt around leaving her mother and sister, both addicted to methamphetamines. By attending to her basic physical needs, especially hunger and rest, she was able to reframe her “abandoning” of her family into the recognition that as a child, she was abandoned by them.

Paying attention to basic physical needs begins to reverse codependency dynamics of over-focusing outward and under-focusing inward. According to codependence expert Nancy L. Johnston, external focus and emotional suppression are two of the four hallmarks of codependent behavior, along with self-sacrifice and interpersonal control.

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Helping clients become aware of biological needs is a critical first step in healing. Empowering them to satisfy these needs is the next step in helping them feel safe and grounded enough to pursue life satisfaction. Providing validation for these unmet physical needs can, at times, be challenging. As much as possible, I guide clients in session to check in with their inner experiences. I am repairing the attachment function of attending to a child’s most vital requirements.

My experience has taught me that in cases of childhood neglect and abuse, not only is there the tension of feeling needs but also accompanying grief, shame, and rage elicited by not having needs met by caregivers. Validating and normalizing having needs while providing opportunities to feel and satisfy them mitigates fears evoked by vulnerable feelings. Healing trauma through this attention can repair the split clients were forced to assume when they buried or negated crucial survival needs.

Questions for Thought and Discussion
In what ways do you resonate with this author’s premise?
In what ways do your PTSD clients neglect their basic bodily needs?
How do you integrate these needs into your therapeutic work with these clients?


File under: The Art of Psychotherapy, Musings and Reflections