Ogden, P., Minton, K., & Pain, C. (2006) | References

What This Research Found

Pat Ogden, Kekuni Minton, and Clare Pain's Trauma and the Body presents Sensorimotor Psychotherapy, a comprehensive approach to treating trauma that addresses what the body holds that the mind alone cannot release. Published in 2006 and now cited over 3,000 times, the book has become foundational in trauma treatment, influencing clinical practice far beyond its specific methodology.

Trauma disrupts the body's capacity for self-regulation. The authors demonstrate that trauma is not merely a psychological event stored in memory but a physiological state held in the body. When threat overwhelms the nervous system's capacity to respond—when fight or flight is impossible and freeze becomes the only option—the body encodes that state as a new baseline. The amygdala remains in a state of hypervigilance, stress hormones like cortisol continue circulating, muscles hold patterns of bracing and defence. This dysregulation persists because it is encoded in procedural (implicit) memory—the same system that stores motor skills and automatic behaviours. You cannot think your way out of procedural memory any more than you can think your way out of knowing how to ride a bicycle. The body must learn new patterns through new experiences, leveraging neuroplasticity to rewire what trauma encoded.

The window of tolerance is central to treatment. Ogden and colleagues introduce the window of tolerance—the zone of arousal within which a person can process experience without becoming either overwhelmed (hyperaroused: panic, rage, flooding) or shut down (hypoaroused: numbness, dissociation, collapse). Within this window, the prefrontal cortex remains online, integration can occur, and new learning is possible. Outside this window, defensive subsystems take over and therapeutic processing becomes impossible—or worse, retraumatising. The goal of treatment is twofold: work within the window to prevent retraumatisation, and gradually expand the window through developing somatic resources. This framework has become ubiquitous in trauma-informed care, influencing treatment approaches far beyond Sensorimotor Psychotherapy.

Somatic resources provide the foundation for trauma processing. Before engaging traumatic material, clients must develop body-based capacities for self-regulation—what Ogden calls somatic resources. These include grounding (sensing contact with chair or floor), centering (awareness of the body's core), boundary awareness (sensing where self ends and environment begins), and movement resources (physical actions that restore a sense of agency). These resources are not relaxation techniques; they are capacities that expand the window of tolerance and provide anchors when processing approaches the window's edges. For survivors of narcissistic abuse who learned to disconnect from their bodies to survive, developing these resources may be extensive preliminary work.

Top-down and bottom-up processing must integrate. Sensorimotor Psychotherapy distinguishes between top-down processing (cognitive, verbal, meaning-making) and bottom-up processing (somatic, sensory, procedural). Traditional talk therapy works primarily top-down; pure body therapies work primarily bottom-up. Ogden argues that comprehensive trauma treatment requires both. Cognitive understanding without somatic processing leaves body patterns unchanged; somatic discharge without cognitive integration may lack stable meaning. The approach teaches clinicians to track both channels simultaneously: What is the client saying? What is the body doing as they say it? When narrative and soma diverge—when someone describes feeling "fine" while their shoulders climb toward their ears—the divergence itself is material for exploration.

How This Research Is Used in the Book

Ogden's Trauma and the Body appears in Narcissus and the Child to explain why body-oriented approaches are essential for recovering from narcissistic abuse. The book uses Sensorimotor Psychotherapy alongside Peter Levine's Somatic Experiencing to address the physical dimension of trauma that talk therapy alone cannot reach.

In Chapter 12: The Unseen Child, Ogden's work is cited in the context of therapeutic approaches for adult children of narcissistic parents:

"Somatic approaches address the body-based imprints of developmental trauma. Levine's Somatic Experiencing and Ogden's Sensorimotor Psychotherapy help clients recognise and release trauma stored in the body—the shoulders raised in perpetual defense, the shallow breathing, the digestive issues from suppressed emotions. For adult children who learned to disconnect from their bodies, this work rebuilds the connection. The body, long experienced as betrayer, gradually becomes an ally."

This passage captures the core of Ogden's contribution: that trauma lives in the body (the raised shoulders, the shallow breathing), that this somatic encoding requires somatic intervention (recognising and releasing), and that for survivors of developmental trauma the goal is not just symptom relief but restored relationship with one's own body. The phrase "the body, long experienced as betrayer, gradually becomes an ally" speaks to the particular experience of survivors whose bodies seemed to fail them—by tensing when they wanted to be calm, by triggering when they wanted to be present, by carrying symptoms that others dismissed or pathologised.

The book's discussion of therapeutic modalities in Chapter 21 (Breaking the Spell) also draws on Sensorimotor Psychotherapy as one of the evidence-based somatic approaches available to survivors, alongside EMDR, somatic experiencing, and Internal Family Systems. This positioning reflects the clinical consensus that Complex PTSD requires multi-modal treatment addressing cognitive, emotional, relational, and somatic dimensions.

Why This Matters for Survivors

If you experienced narcissistic abuse, Ogden's research provides both explanation and pathway—validation of what your body carries and direction toward how it can heal.

Your body's patterns are intelligence, not pathology. The chronic tension in your shoulders, the bracing in your core, the shallow breath that never quite fills your lungs—these are not anxiety disorders or character flaws. They are your body's intelligent adaptation to an environment of chronic, unpredictable threat. Living with a narcissist meant constant vigilance: scanning for mood shifts, preparing for rage, modulating yourself to avoid triggering the next incident. Your body learned to stay ready. The muscles that brace you learned to stay braced. The breath that shallowed to avoid detection learned to stay shallow. These patterns persist because they were encoded in procedural memory, the body's automatic operating system. Your body is not broken; it is doing exactly what it learned to do. Understanding this is the first step toward teaching it something new.

You can learn to feel safe in your body again. Many survivors of narcissistic abuse experience their bodies as enemies—sources of unwanted reactions, embarrassing symptoms, sensations that feel overwhelming or out of control. Ogden's approach offers a path back into the body, not through forcing or overwhelming, but through gentle, titrated attention that respects the nervous system's pace. Somatic resources—grounding, centering, boundary sensing—build the capacity to be present in your body without being overwhelmed by what you find there. Over time, the body that once felt like betrayer can become ally: a source of information, a ground for presence, a home you can finally inhabit.

The window of tolerance explains your variable capacity. If you've wondered why some days you handle stress well and other days the smallest trigger sends you spiralling, the window of tolerance concept provides the answer. Your capacity to process experience fluctuates based on baseline arousal, cumulative stress, sleep, physical health, and environmental factors. When your window is wide, you can stay present with challenging material. When it narrows—as it does under chronic stress, around trauma anniversaries, or when triggered by sensory cues—even minor stressors may push you outside your tolerance zone. This isn't regression or failure; it's the normal functioning of a nervous system shaped by abnormal circumstances. Recognising your window helps you pace yourself, seek support when capacity is low, and develop resources that gradually expand what you can tolerate.

Healing happens through experience, not just understanding. You may understand perfectly why you react the way you do—the dynamics of your narcissistic parent, the patterns of trauma bonding, the neuroscience of chronic stress. This understanding is valuable, but it cannot reach the procedural memory where trauma is stored. Ogden's approach emphasises that the body must learn new patterns through new experiences: safe containment in the therapeutic relationship, successful completion of interrupted defensive responses, gradual exposure to previously intolerable sensations. The mind can understand; the body must experience. This is why insight-oriented therapy often reaches a plateau for trauma survivors, and why somatic approaches can shift what cognitive work cannot.

Clinical Implications

For psychiatrists, psychologists, and trauma-informed healthcare providers, Ogden's framework has direct implications for assessment and treatment of narcissistic abuse survivors.

Assessment must include somatic observation. How does the client sit in the chair? Where is their breath? Do their shoulders rise when they mention the abuser? Do they dissociate when approaching painful material? These body observations are clinical data as important as verbal content. Ogden teaches clinicians to track soma continuously: noticing when body and narrative diverge, when activation rises, when the client exits the window of tolerance. For survivors of narcissistic abuse who have learned to disconnect from their bodies, somatic presentation may be more reliable than verbal report. The client who says "I'm fine" while their jaw clenches and breath shallows is communicating something their words cannot.

Window of tolerance must be monitored and respected. Ogden's framework demands ongoing attention to arousal state. When activation rises—faster breath, flushed skin, restless movement—the client is approaching the upper edge of their window. When shutdown appears—flattened voice, absent gaze, dissociative distance—they've dropped below the lower edge. Processing outside the window risks retraumatisation without therapeutic benefit. Clinicians must learn to slow down, return to resources, and work with smaller pieces of material when the window narrows. For highly traumatised survivors whose windows are narrow, initial sessions may focus almost entirely on resource development rather than trauma processing. This is not avoiding the work; it is building capacity for the work.

Somatic resources must precede trauma processing. Before engaging deeply activating material, the client needs body-based tools for self-regulation. Grounding (sensing feet on floor, back against chair), centering (awareness of core midline), boundary awareness (sensing skin, periphery, where self meets environment), and containment (the ability to hold difficult material without being overwhelmed) are not preliminary to therapy—they are therapeutic. For survivors of developmental trauma from adverse childhood experiences whose early environments provided no co-regulation, these resources may need to be explicitly taught rather than assumed. Skipping resource development in favour of trauma processing courts retraumatisation.

Integration of top-down and bottom-up processing requires clinical flexibility. Different clients need different balances. Some present with primarily cognitive processing, intellectualising trauma while remaining disconnected from body experience. These clients need more bottom-up work: attention to sensation, permission to feel, completion of defensive movements. Others present with primarily somatic processing: overwhelmed by sensation, awash in body experience without narrative container. These clients need more top-down work: naming, meaning-making, cognitive organisation of experience. Most survivors of narcissistic abuse have learned to disconnect from their bodies (a survival strategy) and may initially resist body-focused work. Meet them where they are while gradually expanding into somatic territory.

Consider adjunctive body-oriented treatment. Even clinicians not trained in Sensorimotor Psychotherapy can incorporate somatic awareness into their work, and can refer for specialised body-oriented treatment when standard approaches plateau. Survivors of chronic developmental trauma often benefit from combined approaches: talk therapy for meaning-making and relational repair, body-oriented work for patterns that cognitive approaches cannot reach. Yoga, somatic experiencing, and Sensorimotor Psychotherapy itself offer options for the somatic dimension. The clinician's role may be to coordinate an integrated treatment approach rather than provide all modalities themselves.

Broader Implications

Ogden's work extends beyond individual treatment to illuminate patterns that affect families, workplaces, and social systems.

The Intergenerational Transmission of Dysfunction

Parents carry trauma in their bodies, and dysregulated bodies cannot provide the regulated co-presence that children need. A parent whose shoulders are chronically raised, whose breath is perpetually shallow, whose startle response fires at minor sounds, creates an environment of transmitted activation regardless of conscious intention. Children's nervous systems mirror and internalise caregivers' states; a narcissistic parent whose body is dysregulated teaches the child that dysregulation is normal. This explains how intergenerational trauma operates at the somatic level: not through genetic inheritance of memories, but through the practical reality that traumatised bodies raise children in traumatised ways. Interrupting this cycle requires healing the parent's somatic patterns, not just their psychological understanding.

Relationship Patterns in Adulthood

The body's learned patterns shape whom we're drawn to and what we tolerate. A nervous system calibrated to chronic threat may experience calm as unfamiliar and therefore suspicious. The regulated partner feels "boring"; the chaotic one feels "exciting" (which is actually the familiar feeling of activation). Bodies trained in trauma bonding seek relationships that provide intermittent reinforcement: unpredictable alternations between connection and rejection that feel like love because they match the template of early attachment. Recovery involves not just cognitively recognising unhealthy patterns but somatically learning new patterns—teaching the body that regulated relationships are safe, that calm can be trusted, that excitement is not the only form of aliveness.

Workplace and Organisational Dynamics

Survivors of developmental trauma bring dysregulated nervous systems into work environments that may inadvertently activate old patterns. The critical supervisor echoes the narcissistic parent; the unpredictable work environment triggers chronic hypervigilance; the open office provides no space for the nervous system to regulate. Ogden's framework suggests that workplace productivity is a nervous system issue as much as a motivational one. Organisations that provide predictable environments, private spaces for regulation, and management practices that don't inadvertently retraumatise may get better performance from employees carrying trauma histories. The window of tolerance applies to work capacity: on narrow-window days, even competent employees may struggle with tasks they handle easily when their window is wide.

Institutional Care and Policy

Ogden's emphasis on the body has implications for how institutions serve traumatised populations. Healthcare settings that require patients to lie still and submit to procedures may retraumatise those whose trauma involved loss of control over their bodies. Mental health intake procedures that demand detailed trauma history before establishing safety may exceed clients' windows of tolerance before treatment even begins. Educational settings that punish children for trauma-driven behaviour (hyperactivity from chronic hyperarousal, dissociation from overwhelming stress) compound rather than address the underlying dysregulation. Trauma-informed institutional practices—those that consider the body's needs for safety, predictability, and agency—represent application of Ogden's insights at scale.

Legal and Policy Considerations

Courts and policy systems often expect rational, verbal accounts from trauma survivors whose bodies hold what words cannot capture. The witness whose voice trembles and whose narrative fragments may be seen as unreliable when in fact they are demonstrating typical trauma presentation. The parent in a custody dispute whose dysregulation in court is taken as evidence of instability may actually be showing the impact of the domestic violence she is alleging. Ogden's framework suggests that somatic presentation should inform legal understanding: trauma disrupts the capacity for coherent narrative, and body symptoms are evidence of experience rather than unreliability. Policy that affects traumatised populations should account for what bodies carry that depositions and testimony may miss.

Public Health Framework

Viewing trauma through Ogden's somatic lens reframes it as a physiological condition with population-level prevalence and consequences. The adverse childhood experiences (ACEs) literature documents what happens when bodies develop under chronic stress; Ogden's work explains the mechanism. Children raised in narcissistic family systems develop nervous systems calibrated to threat, bodies braced for danger, procedural memories of dysregulation that persist into adulthood. The public health cost appears in healthcare spending (for somatic symptoms and trauma-related conditions), disability (from chronic dysregulation that impairs function), and lost productivity (from nervous systems too activated to perform). Prevention—reducing childhood adversity, supporting parents, providing early intervention when trauma occurs—addresses the body's development before dysregulated patterns become entrenched.

Limitations and Considerations

Ogden's influential work has limitations that warrant acknowledgment.

The research base is growing but remains developing. While clinical outcomes support Sensorimotor Psychotherapy's effectiveness, randomised controlled trials are fewer than for some other trauma treatments. The approach's emphasis on subjective body experience makes standardised research methodology challenging. Clinicians should be transparent about the state of the evidence while remaining open to approaches that may help where others have plateaued.

Individual differences in body awareness vary widely. Sensorimotor Psychotherapy assumes capacity for interoception—awareness of internal body states—that some clients may lack. Survivors with significant dissociation, alexithymia, or developmental disruption of body awareness may need extensive groundwork before body-focused interventions become accessible. The approach requires adaptation for these populations, not automatic application.

Cultural considerations require attention. Concepts of the body, its relationship to self, and appropriate ways of attending to it vary across cultures. Western assumptions about individual body ownership and private processing may not translate across cultural contexts. Body awareness practices may carry different meanings in different cultures. Clinicians must adapt the approach's principles to cultural context rather than imposing Western somatic frameworks universally.

Accessibility of specialised treatment remains limited. Full Sensorimotor Psychotherapy training requires significant investment; trained practitioners are not available in all communities. The approach may be more accessible to privileged populations with resources to access specialised care. This raises equity concerns about who benefits from body-oriented trauma treatment.

Historical Context

Trauma and the Body appeared in 2006, building on decades of development in body-oriented therapy while integrating emerging findings from neuroscience and attachment research. Pat Ogden's journey began in the 1970s when she noticed that clients' unresolved trauma manifested in posture, movement, and bodily holding patterns. Working initially within Ron Kurtz's Hakomi method, she developed an increasingly distinct approach that became Sensorimotor Psychotherapy.

The book's collaboration between Ogden (a somatic therapist), Minton (a clinical psychologist), and Pain (a psychiatrist) was strategically significant. Body-oriented therapies had long been marginalised as "alternative" approaches lacking scientific rigor. By partnering with mainstream clinical psychologist and psychiatrist co-authors, grounding the approach in attachment theory and neuroscience, and publishing with W.W. Norton (a major clinical publisher), Ogden brought body-oriented trauma treatment into mainstream clinical discourse.

The book built on Peter Levine's Waking the Tiger (1997), which had introduced the idea that trauma is stored in the body and must be released there. Ogden's contribution was more systematically clinical: a comprehensive framework for assessment, treatment planning, and intervention that integrated body-oriented work with cognitive approaches. The window of tolerance concept, while drawing on Daniel Siegel's earlier work, became systematised and operationalised for clinical use in ways that made it accessible to practitioners across theoretical orientations.

Trauma and the Body has been cited over 3,000 times. The window of tolerance concept has become ubiquitous in trauma-informed care, appearing in clinical training, psychoeducation materials, and popular discussions of trauma. The Sensorimotor Psychotherapy Institute now offers training internationally. The book established body-oriented trauma treatment as a rigorous clinical approach rather than an alternative curiosity, influencing how a generation of clinicians understands and treats complex trauma.

Trauma and the Body: A Sensorimotor Approach to Psychotherapy

APA Citation