238 The Role of Touch in Therapy | Ethics, Best Practices, & Healing: Interview With Sarah Levant

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We dive into how touch when used ethically and skillfully can help support nervous system regulation and help clients heal. You'll hear insights from my guest, Sarah Lavan, on how touch can be a powerful tool for anchoring clients in present moment safety, the importance of co-regulation. As well as informed consent practices.

This conversation offers a thoughtful look into how embodied connection can transform the therapeutic process. On today's episode of Yoga in the Therapy Room podcast, thanks for being here. Welcome to Yoga in the Therapy Room, the non-traditional therapist guide to integrating yoga into your therapy practice.

Join me on this journey to help you be one step closer to bringing yoga into your therapy room.

Welcome to the Yoga In the Therapy Room podcast. The non-traditional therapist guide to integrating yoga. Into your therapy practice. I'm your host, Chris McDonald. Today we're exploring the powerful role of touch in psychotherapy. I'm joined by somatic therapist Sarah Levant to discuss how safe, intentional touch can support healing from developmental trauma and deepen the mind body connection.

Sarah also assisted national and international trainings on trauma and somatic healing. Welcome to the Yoga in the Therapy Room podcast, Sarah. Oh, thank you so much for having me. I'm excited to have you. Can you share how you first discovered yoga?

Sarah Levant: Sure. I was actually in high school and it was during my ski team.

Chris McDonald: And how did you become interested in somatics and trauma? Oh

Sarah Levant: boy. Great question.

Chris McDonald: Uh, yeah, I know you're passionate about this.

Sarah Levant: Yeah. Well, uh, me search, I noticed from my own system that talk therapy just didn't do it for me, and it really started when I was working in Washington, DC. With young adults who were homeless and struggling with addictions, involved with gangs and crews.

So I, I was wondering, what is this? It got me really curious. And that led me to read the book, waking The Tiger by Peter Levine. And, uh, Peter Levine is the individual who created Somatic Experiencing. Um, so after I read that book, I was sold and yeah, haven't looked back. I'm a licensed clinical social worker and I'm.

I consider myself a body psychotherapist.

Chris McDonald: Yeah, I love that because I know, I hear a lot of people call themselves somatic therapists, but a body psychotherapist, it's really bringing that body into the therapy room. It's, it's so powerful. And I love how you said, witness the parasympathetic response. So isn't it like magic when you can witness the parasympathetic response?

It's,

Absolutely. It has its place. I got my Master's of Social work at the same time that I got my certification for Somatic Experiencing practitioner to get to the root of many of what we call disorders. It's. Nervous system dysregulation.

Chris McDonald: Absolutely. And helping clients to understand that and helping them find ways to, so they can get their parasympathetic turned on.

Right. When they're feeling dysregulated. Yeah. So, so such empowerment. Well, I know another way that empower clients is through touch, and that can be kind of controversial in the therapy room. So can you talk about the power of touch in therapy?

Sarah Levant: I would love to. And I wanna preface this by saying, if you had met me 10 years ago, I was very anti touch.

Yeah, tell, tell me about that Psychotherapy. Yes. Many people believe, oh, I'm a licensed clinical social worker, or I'm a psychologist or counselor. I can't touch my clients. Actually, no. If you contact your boards in most states. With the exception of a few. And that's changing because of the research. Uh, you can touch your clients if you have training.

I'm gonna put a star there. Training is essential as well as getting consults, having a community, because if you think through talk therapy that, oh, there's a lot of calendar transference and transference going on, there's even more through touch. The practitioner, you feel it because you're touching the client, but the client is also touching you back.

The rays of light go through the eyes, smell touches the nose, sound touches the ears, food touches the tongue. So touch is the mother of all the senses. It's our first language. So with touch, and there's many, many trainings out there for psychotherapists as well as different healing practitioners. You touch into these pre-verbal states, so touching into these parts of self where memory is stored.

It can be strange for the practitioner as well as the client, but at the same time, you're shifting the nervous system to have greater capacity. So for some of your listeners, maybe familiar with the window of tolerance. So you're widening the window of tolerance in a way that talk therapy can't get to, and you're literally changing the set point of the nervous system.

You're changing. The homeostasis of the nervous system. So when you do that, it doesn't necessarily feel good all the time. There'll be times when clients have headaches. There'll be times when clients have stomach aches or, or more reactive because the nervous system, what we know orients to what is familiar and anything different is.

Chris McDonald: I imagine that's difficult to shift, to do something different too, 'cause it can bring up some discomfort.

Sarah Levant: Absolutely. And that's why additional training is so important for with the practitioner. So the practitioner can really inform the client of what to expect.

Chris McDonald: And what was the trainings that you've had with Touch?

It's called Somatic Resilience and Regulation. And for your listeners out there, if anything that I've said, uh, interests you get their book now, please. It's called Nurturing Resilience by Kathy Kane and Steven Terrell. They wrote that book and then they created the training together and that book is, uh, required reading.

In that book, it's all about somatics. It's all about developmental trauma and the latest research. So their training is all about touch or just even understanding how it works. There's many people that go through that training and don't incorporate touch, but at least you're familiar with it. You understand the nervous system even more about your own regulation as well as the clients and how to.

Shift homeostasis, how to widen that window of tolerance. So that is an incredible, powerful training as well as learning about the client's attachment system as well as your own as a practitioner. So it's an amazing training. So I've done somatic experiencing somatic resilience and regulation. And then Steve Terrell, who I just mentioned, he has his own training.

So the nervous system can let go faster because it knows what to expect and widen that window of tolerance faster. What's also fascinating about. Um, transforming the experience-based brain, also known as TEB. It incorporates primitive reflexes, which to my knowledge, no other somatic training does. And for those of you out there, this is more of like the occupational therapy world.

What happens with developmental trauma or intergenerational trauma is that these primitive reflexes aren't organized in the way that they should, so then they become retained and it makes life harder because when you have retained primitive reflexes as an adult. Because these primitive reflexes are supposed to fade away in infancy, it makes life a lot harder as an adult when they're retained.

So it adds to the accumulation of stress in the nervous system. It's called allostatic load. So with transforming experience-based brain, we use the attachment system to help integrate these different primitive reflexes. In a way that's different than how OTs do it. Many times OTs do repetitive movements, especially in children, to help these reflexes integrate or send worksheets home.

And when that starts to happen, people's lives. Truly start to transform. So I, I mostly actually do TEB because just you see such a transformation in the clients. And with TEB, yes you do primitive refluxes, but there's also a spot in the protocol for enhancements. So you can bring in EMDR there, you can bring in different yoga asanas or breathing techniques.

You can bring in brain and spotting, which I frequently do. I'm also trained in safe and sound protocol and rest and restore protocol. So there's many times that I incorporate all of these modalities in a single session.

Chris McDonald: Wow. I love how integrative you are.

It's not a one size fit all we gotta find court True. For each person.

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Sarah Levant: Great question. So if we're doing the TEB protocol, and again, training is number one. Sure. Because there's, there's many layers to this, but it could be supporting the brainstem and the kidney adrenals, the shoulders.

The wrists, the ankles, and then at the end doing what's called limbic installation. With the toes and the the feet pressing out, or with the enhancements, it could involve supporting different primitive reflexes like fear paralysis, which involves supporting the knees and gently moving the knees to start to open up the pelvis or the mediastinum, which is the connective tissue that surrounds the heart, the lungs.

Through it, it might look like just me supporting your pinky or the your heel bone. Where can we join? Where can we meet that will feel tolerable to your system? Nowhere. Okay. Well, let's just talk about it.

Chris McDonald: So meeting them where they're at.

Sarah Levant: Oh, a hundred percent. All right. Well, how, how about if you touch the back of my hand?

Can we meet there? So finding some way to meet the client and join with them. So everyone is fully clothed. And the TB protocol is very, very exact and very clear because again, when there's cognitive safety and somatic safety, that's where healing can happen because that's where the trust is.

Chris McDonald: So I take it that's, it's a gradual process too, to bring that safety and to move further with the protocols.

And

Sarah Levant: absolutely. Safe enough. Safe

Chris McDonald: enough, safe enough.

Sarah Levant: Yeah. Yeah. And just because you're not ready this week. Okay. We'll try again next week.

Chris McDonald: That's okay.

It needs to be in the room. It needs to be, it's all about counter transference. Because we heal deeply when we're in a relationship.

Chris McDonald: Well, how can early attachment impact the body and a person's relationship to touch?

Sarah Levant: Oh my goodness. What a great question. You may be familiar with the Adverse Childhood Experience study.

Yes. Mm-hmm. Um, I'm not sure if your listeners are, but it was. A study, um, initially created by, uh, a health insurance company out in California. It's called Kaiser Permanente, and it started with a weight loss clinic. And they couldn't, the doctors, the most successful patients who lost the most amount of weight, they dropped out of the study and the doctors did not understand why.

So basically there's different. Measures a safety in the ACE study, the Adverse Childhood Experience Study, whether or not you experienced physical abuse, whether or not your parents were divorced. It's just 10 questions. It's a questionnaire, so the more ACEs you have, the more likely you are to have vulnerabilities with addictions.

It helps chronic conditions have less flareups. Again, it widens the window of tolerance. So the nervous system doesn't have to work so hard because when we have these really challenging events in childhood, life is scary. And when life is scary, we tend to exit the present moment when we don't have a safe person to co-regulate with.

And this is the idea behind the faux window. So I mentioned the window of tolerance earlier. Steve and Kathy Kane popularized the idea of the faux window. So what is the faux window? It's basically how when you chronically live outside of your window of tolerance, and individuals who have a high ace core do live outside of the window.

It might be using substances, it might be using alcohol or gambling or sex. Um, and all these things come at a cost. It hits the immune system. It takes a hit cognitively, uh, we just don't have the mental capacity. When we're just leaning on all these external things, uh, our relationships take a hit. So with touch, what we do is basically make that full window smaller so we can organically live more in that window of tolerance so it frees up more space so we can breathe, so we can sit and feel floor beneath our feet without running from one thing to the next.

So touch again. I truly believe is the keystone in healing. That's, we don't talk about it enough.

Sarah Levant: that's a great question. So with the lens that I work from, that's a trauma reenactment.

You've spent your whole life taking care of yourself. You spent your whole life alone because you didn't have those caregivers to lean on. They weren't available maybe physically or emotionally. So what we do is I become in that session, that secure base for you through this lens, and when you start to feel safe enough with me.

You don't need to hold your own heart. You don't need to hold your shoulder or your head because you can start to let go in the connection. You don't have to work hard with me. You can just be, and then I support all parts of you. You don't have to smile. You don't need to be nice. You don't need a people, please.

You can be angry. You can have that rage come out. You can have that grief come out, and that's when the magic. Truly starts to happen.

Chris McDonald: So when they can be their full self and authentic self. Absolutely. So I take it, does this use IFS or parts work as well?

Chris McDonald: Internal family systems for those that aren't aware.

Sarah Levant: Yes, these different parts of you, but with touch and through TEB as well as somatic resilience and regulation, you touch into those parts like it's, it's, it's wild, it's trippy. You can actually start to feel as the practitioner, these different parts come forward.

Wow. It's wild. It is fascinating. I don't know how it works. I work with everyone like and including dissociative identity disorder, so DID, where there's these parts of self where people needed to create these parts in order to feel safe. So it's absolutely fascinating me to feel when these sh parts start to shift as well as for individuals who don't have the diagnosis of DID, you need to feel these show somatic.

Shifts starting to happen.

Chris McDonald: And what are these shifts that you mentioned? Oh my

You can start to notice the shifts happening in your own system while you support the other system. I don't know what it is, but I am, I, I attribute it to mirror neurons. Yeah, because there's nothing else in the research that I can attribute it to. So you start to notice these different things, these shifts, movement, you can actually start to feel the kidneys start to move.

You can start to notice swelling sometimes, or sudden coldness like with the freeze response or collapse, like the client will suddenly feel like ice. Interesting. Where my hand will start to feel like ice. Yes. It's absolutely water. I've never heard of this. Wow. Oh my goodness. It is trippy. Like I keep 'cause there's nothing else.

Chris McDonald: Healing

Sarah Levant: real time. Yeah. Yeah. You get to be a witness to it. It looks different and that's why it's so important to have.

Consults and trainings because it is so different. And if the practitioner gets scared, healing stops

Chris McDonald: true. Yeah.

Sarah Levant: When fear enters a healing stops, okay. Healing stops. Because you're no longer in that parasympathetic state, the practitioners out of their window, you no longer can co-regulate or offer co-regulation.

It's really important that the practitioner is as embodied as possible and. Regulated as that can be. And that changes day to day. I mean, I have two young kids, of course there's some days I get three hours of sleep and our best changes day to day, and that's okay. And to have grace for ourselves and model that for our clients.

Chris McDonald: Yeah. What about informed consent with touch? Is that different?

Sarah Levant: Oh my goodness. Yes. Uh, that is everything. Everything. So when people come see me, I have, um, informed consent for everything. The pros, the cons, why I am suggesting it.

Um, I'm very clear, very, very clear, and the client signs it and I send them a copy. And every single session we have, I make it very clear what we're doing. I'm gonna place my hand on their shoulder. I'm gonna place my hand on your brainstem. I'm gonna place my hand on your ankles, wherever we will be. I never ever touch where I, I don't get permission and I get permission at the beginning of every single session.

And there are individuals that I've worked with for years and they kind of waved me off. Yeah. Yeah. Sarah, you got my permission. I was like, thank you. And we're gonna walk through mm-hmm. Each point. Absolutely. 'cause I know that that young nervous system that's inside of 'em, that part, they never had that choice.

Chris McDonald: That sounds very trauma informed too, knowing what to expect and what's coming up.

Sarah Levant: Absolutely. With these approaches, they are, they're the essence of trauma informed care.

Chris McDonald: Yeah. Same as bringing yoga practices in that we have to get informed consent each time.

Every time, because nobody shows up the same.

Sarah Levant: No. Ever. Ever.

Chris McDonald: And we don't.

Sarah Levant: Yes. And it's tempting just to get the ball rolling, but that is just so important every single time.

Chris McDonald: Is there any other ethics that therapists should be aware of with touch in the therapy room

Sarah Levant: form consent training? I think it's even more important to have a community.

Because when we start to interfere as practitioners, that's when healing stops as well, because that's our need to help to fix, oh, let me make sure the client's okay. No, no, no. A big part of healing is actually suffering. And getting uncomfortable, but how to support it in a way where we can support it to feel tolerable and without shame authentically.

Chris McDonald: That's so important. It sounds like you're very accepting and allow who, whoever shows up, whichever part or emotions show up to be present. Yeah, we have to be.

Sarah Levant: We have to be. Because if I reject any parts of you, right? Again, healing then will be limited. So how to work with my own system, how to get the support I need or the training that I need so I have greater capacity to be with you.

Chris McDonald: True. So it sounds like a lot more work has to be done in our work for therapists own stuff. I believe so. Yeah. That makes sense.

Is there any legalities involved with this as well? Because I know documentation could be important, I'm sure, in sessions and

Sarah Levant: Yeah, I've never had an issue with it. I, I'm very clear in my case notes what I'm doing very clear, and I've never had an issue with insurance or single case agreements. If anything, I find it, there's such a need.

And it's easier to get single case agreements or authorizations, make it more widely available because the individuals that I work with, they tend to be the most complex, uh, complex medically as well as they tend to, these individuals have seen. I'm usually like their 15th therapist. They've tried talk therapy, they've tried all the different medications out there, but something's still missing.

Something isn't quite right.

Sarah Levant: boy. You got a lot. Yeah. Let me think because I wanna be mindful of. Sure. Identification. I work a lot with addictions and disordered eating, and it's, it's such an honor to witness and hold space for people who move past it.

Um, whether it's. Individuals who have been restricting their whole life and then finally no longer doing it, or being super sensitive to food and taste sensitivities of the diagnosis of Arfid, and then being able to go to their favorite restaurant and eat anything off the menu. So the world really opens up when we have more capacity, and that's what Touch does.

Because again, it's amazing. It, it is what the nervous system can do. And again, I'm not doing it. I'm just supporting right. The individual system, reducing that accumulation of stress, which is the allostatic load to free up more space for the nervous system to do its job, which is to heal. So when we reduce the stressors, when we allow more space within the nervous system, it can do it.

Chris McDonald: Oh, I really appreciate that. And I think therapists listening too, if you're hesitant about this too, just check with your own licensing boards. 'cause this podcast does go around the world. Absolutely. And we can't possibly know every regulation and law, so just make sure that you're checking with your own board and any other regulations.

But is there anything else you wanted to share about therapists who might be interested in integrating Touch but aren't sure where to start?

Somatic experiencing training is great. Um, but I will say TEB transforming experience-based brain is a lot more affordable. And there's actually free consults on Thursdays, so Steve Terrell is very generous. Yeah, and just to connect with other like-minded people. There's, there's a growing somatic community.

There's sensory motor psychotherapy, there's omi, brain spotting. There's so much out there. So it's just stay curious because if we think we know the answer again, healing stops. Yeah, for sure. We're not open to the possibilities we need to be, and that's what somatic is, and I think that's why it can feel so threatening to people.

True. Because it's so different. We don't have all the answers.

Chris McDonald: What's the best way for listeners to find you and learn more about you?

All these ideas as well as the most recent research and how to support healing in the mind body connection.

Chris McDonald: That sounds wonderful. Thank you so much for coming on the podcast today, Sarah.

Sarah Levant: That's my honor. Thank you.

Chris McDonald: That brings us to the end of another episode. Be sure to tune in next Wednesday when another episode drops.

Thank you listeners for tuning in today. Are you ready to bring the transformative power of yoga into your therapy sessions with confidence and ease? I've got a free resource just for you called Building Confidence and Competence in Integrating Yoga Into Therapy Sessions, a thoughtfully designed checklist to help you navigate best practices and feel empowered as you blend yoga and therapy.

Till next time, take care. Thanks for listening to today's episode. The information in this podcast is for general informational and educational purposes only. It's given with the understanding that neither the host, the publisher. Or the guests are giving legal, medical, psychological, or any other kind of professional advice.

We are not responsible for any losses, damages, or liabilities that may arise from the use of this podcast. Yoga is not recommended for everyone and is not safe under certain medical conditions. Always check with your doctor to see if it's safe for you. If you need a professional, please find the right one for you.