When working with a client’s nervous system, what appears in the present moment does not always belong only to the present. A sensation, movement, or pattern of activation may be connected to several earlier experiences that have become linked within the physiology. Having a broad understanding of the client’s trauma history can therefore help us recognize these connections and support the process more effectively. In this article, I want to explore why a trauma history intake can be so important when working with Somatic Experiencing®.
Why the Broader History Matters
A client came in with an issue involving her partner. The work touched on relational trauma in two ways. On the one hand, she wanted to be able to speak her truth to her partner. On the other hand, because she usually felt responsible for dealing with everything, she wanted to feel that this particular issue was not something she had to fix or take care of. She also shared that, during her childhood, she had to become a mother to her younger brother and take care of herself. This included preparing food, doing household chores, managing bedtime routines, and more. Developmental experiences such as these may become organized not only as beliefs and relational expectations, but also as enduring bodily, emotional, and psychomotor patterns [1].
As we started to work with the current situation involving her partner, she began to experience tension in her throat. If we had focused only on the information about speaking her truth, this tension would already have made sense within that relational context. Without knowing her trauma history, I would typically have phrased my questions in a way that kept the relational context at the center of her experience.
However, I also knew parts of her trauma history, and two other events from that history seemed potentially important. One occurred after one of her surgeries went wrong: she vomited into her throat, was unable to clear it, and feared that she would suffocate. Another occurred during a suicidal period, when she survived an attempt to hang herself and had a rope around her throat. Both events may also have had a physiological impact in the area of her throat.
Understanding Overcoupling
In Somatic Experiencing®, we use the term overcoupling. This means that two or more elements or events have become strongly linked. When one is experienced, the other will also tend to be experienced. A simple example is anxiety (affect) and unease in the stomach, usually experienced as contraction (sensation). When our client begins to feel one, the other often automatically arises as well. This also means that if the stomach contracts because of something they ate, anxiety will most likely be experienced when these elements are overcoupled. Put another way, overcoupling creates patterns in our physiology.
Just as different elements can become overcoupled, different traumatic experiences can also become overcoupled. In Somatic Experiencing®, the interconnected pattern of sensations, emotions, images, meanings, movements, and survival responses organized around a traumatic experience is called a trauma vortex. The word vortex reflects how contact with one part of the pattern can draw the nervous system into the wider experience, bringing other linked responses into activation [2].
When several trauma vortices have become overcoupled, activating one may also activate responses associated with the others [3]. The client’s physiology may then respond to several linked traumatic experiences at once, increasing the intensity of the activation and making it more difficult to regulate.
When we do not know a client’s trauma history, we are working blind. When we observe activation or a reactive pattern in the client’s nervous system, we have no clear sense of the overall picture. It is like entering a dark tunnel with only one small match to light the way. The chance of getting lost is relatively high. When we know more of the trauma history, we enter that same dark tunnel equipped with flashlights. It becomes easier to find our way.
Recognizing Patterns Across Experiences
Of course, it is quite possible that a client does not remember all the specific events or moments in their life that affected their physiology but were not fully integrated. There will always be events, or details of an event, that only surface during a session while the client is working through activation. What is important is that we begin to develop a broad overview and recognize patterns in their trauma history.
For instance, one of my clients included the following events on her trauma history intake form: a fall in which she broke her right collarbone; a blow to the head coming from her right, which resulted in a concussion; surgery on her right eye; and an abusive father who always sat to her right at the dinner table. Here, too, we can see how all these events may become overcoupled in her physiology.
Many clients seek help for difficulties in their relationships, just as this client did. The client herself may be able to connect these struggles to earlier relational experiences—in this case, to her abusive father. However, if we work only in the relational and attachment realms, we may become stuck. Certain incomplete responses, such as those connected to the fall, surgery, or concussion, are then less likely to be addressed in ways that could lower the activation and help uncouple these different traumatic events.
Even when our clients remember certain events, they may not realize that an event is clinically relevant. When we conduct a trauma history intake, it is therefore important that we guide our clients and ask for more detail where necessary.
Returning to Present-Moment Work
Returning to my client with the tension in her throat, I invited her to let go of the story for a moment and simply stay with the tension, bringing curiosity to what wanted to happen. As soon as she did this, a memory of one of the surgeries resurfaced. She could feel both the impulse to get something out and the experience of not being able to breathe. As she stayed with these sensations, the tension softened and more of her physiological experience came into awareness.
As we continued to explore what wanted to happen next, an image of herself hanging from the rope suddenly resurfaced, together with the memory that she chose to breathe and stay alive. At that moment, there was a larger release in her physiology. More breath could move through her, and there was a greater sense of coherence. I had not prompted her to recall these events during the session. However, because I knew they had happened, it was easier for me to support her in allowing her physiology to do what it needed to do.
At that point, with much more regulation in her system, I invited her to bring the current situation with her partner back into her awareness. As her physiology and the activation within the familiar pattern had shifted, her relationship to the current situation had shifted as well. More possibilities became available, and she felt a greater sense of agency. Based on several such experiences, I believe these shifts would have been less likely if I had not had the information from her trauma history intake.
History as a Map, Not an Explanation
A trauma history intake is not meant to give us a fixed explanation for everything that emerges in a session, nor does it mean that we need to actively search for past traumatic events. The client’s present-moment experience and physiology remain our primary guides. However, knowing their broader history gives us a more complete map and helps us stay open to connections that might otherwise be overlooked. This can support us in asking more attuned questions and recognizing when several experiences may have become overcoupled. In this way, a trauma history can help create more possibilities for regulation, uncoupling, and a renewed sense of agency.
Note: In SE, taking a trauma history follows the principle of pendulation: we gently move between difficult or traumatic experiences and positive, supportive aspects of the client’s life (resources), helping the process remain manageable and regulated.
Confidentiality note: The clinical material in this article is shared with the clients’ informed consent. Identifying details have been changed or omitted to protect their privacy.
References
- Bentzen, M., Levine, P. A., & Jarlnæs, E. (2004). The body self in psychotherapy: A psychomotor approach to developmental psychology. In I. Macnaughton (Ed.), Body, breath, and consciousness: A somatics anthology (pp. 51–70). North Atlantic Books.
- Payne, P., Levine, P. A., & Crane-Godreau, M. A. (2015). Somatic experiencing: Using interoception and proprioception as core elements of trauma therapy. Frontiers in Psychology, 6, Article 93. https://doi.org/10.3389/fpsyg.2015.00093
- Levine, P. A. (2015). Trauma and memory: Brain and body in a search for the living past—A practical guide for understanding and working with traumatic memory. North Atlantic Books.