Trauma-Informed Grounding Techniques: Essential Tools for Therapy

This article explores how various trauma grounding techniques work, their application, and the importance of tailoring these methods to each client’s unique needs.

Learning Outcomes

• Understanding trauma: Trauma is not about the event but about the unhealed wound it leaves within a person, affecting their ability to be present and to respond flexibly.
• Body’s response to trauma: The body’s stress response involves cortisol and adrenaline, which mobilise defensive actions. Unresolved trauma results in these responses remaining active.
• Importance of grounding: Grounding techniques help to bring clients back to the present, making them feel safe and enabling rational thought.
• Various techniques: Techniques include orienting, containment, accessing cranial nerves, breathwork, movement and co-regulation.
• Practical application: These techniques should be tailored to individual clients, practised in safe environments, and explained to ensure that clients understand their purpose.

Understanding Trauma and the Body’s Response

Trauma is an internal reaction to distressing events, manifesting as an unhealed wound that impedes a person’s emotional and cognitive flexibility. Gabor Maté highlights that trauma isn’t about what happens to someone but about how they internalise and react to it. This unhealed trauma can keep individuals in a hyper-vigilant state, making it challenging for them to stay in the present.

Trauma is not what happens to a person, but what happens within them. In line with its Greek origins, trauma means a wound – an unhealed one, and one the person is compelled to defend against by means of constricting his or her own ability to feel, to be present, to respond flexibly to situations.

Gabor Maté (Hoffman Institute, n.d., para. 3)

The body’s response to trauma involves increased cortisol and adrenaline, mobilising defensive actions, e.g. fight or flight. Ideally, the body returns to calm once the threat is gone. However, unresolved trauma can leave these stress responses active, keeping individuals in a state of constant alertness or shutdown (Schwartz, 2020).

‘Traumatised people feel chronically unsafe in their bodies. The past is alive in the form of a gnawing interior discomfort. Their bodies are constantly bombarded by visceral warning signs.’

Bessel van der Kolk (2015, p. 97)

Key Theories and Concepts

1. Polyvagal theory: This theory, developed by Stephen Porges (2017) and expanded by Deb Dana (2018), emphasises the role of the vagus nerve role in regulating safety and social engagement. It explains how trauma affects the autonomic nervous system, and highlights the importance of working with the body to calm the mind. By engaging the parasympathetic nervous system through grounding techniques, therapists can help clients to relax their bodies and minds.
2. Somatic experiencing: Peter Levine’s approach (1997, 2010) focuses on resolving trauma stored in the body through physical sensations and movements, helping clients to process and release unspent stress responses.

When Might We Use Grounding Techniques With Clients?

Before your clients begin to explore something traumatic, you might practise some of these with them so that they know that they can find a way back to the here-and-now safely. Agree which one or two work best for the client, how you might use them in the therapy room, and how the client might also use them outside the therapy room. Notice when they may be moving into defensive, survival responses (fight, flight, freeze or collapse), and remind them of the agreed techniques.

Remember: Rational thought is difficult to access in these states, so we need to calm the body before we can engage the brain in rational thought.

Recognising When Clients Need Grounding

As therapists, we can identify when clients need grounding by observing their defensive survival responses. These responses typically manifest in two primary states: fight-or-flight and shutdown.

By recognising these signs, therapists trained in trauma-informed practice can use appropriate grounding techniques to help clients to regain a sense of safety and to reconnect with their rational thinking.

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The Importance of Psychoeducation

Psychoeducation plays a crucial role in trauma therapy. By explaining the physiological basis of grounding techniques, therapists empower clients to understand their responses and actively participate in their healing journey. This fosters trust and collaboration between the therapist and client, leading to more effective trauma treatment.

Re-Traumatisation and Working with the Client

Therapists must be vigilant about the risks of re-traumatisation and vicarious trauma when employing grounding techniques. The techniques themselves, if not appropriately applied, can trigger distress or exacerbate existing trauma. Establishing a safe and trusting therapeutic relationship before introducing grounding exercises is crucial.

Grounding techniques should always be an invitation, not a mandate. Clients should feel empowered to choose which techniques resonate with them, and have the autonomy to decline any that feel uncomfortable or unsafe.

Informed consent is paramount. Therapists should thoroughly explain the rationale behind each technique, ensuring that clients understand the potential benefits and risks. This empowers clients to make informed decisions about their therapeutic journey.

Care must be individualised: each client’s trauma history and nervous system responses are unique, and what works for one client may not work for another. Therapists should avoid making assumptions and remain adaptable, tailoring their approach to each client’s specific needs.

Grounding Techniques for Trauma-Informed Therapy

1. Orienting

Orienting involves directing attention to the present moment through sensory awareness. This technique, often called ‘grounding’, helps clients to connect with their immediate surroundings and reduces feelings of dissociation (Schwartz, 2020).

Practical steps:

• Ask clients to name five things they can see, four things they can hear, three things they can feel, two things they can smell, and one thing they can taste.
• Encourage clients to say these things out loud for better engagement.

2. Containment

Containment techniques help clients to feel safe within their own bodies, creating a sense of boundary and security (Levine, 1997, 2010).

Practical steps:

• Hand on heart: Place one hand on the heart and the other on the forehead. Breathe deeply until a sense of calm is achieved.
• Butterfly hug: Cross arms over the chest, with each hand on the opposite shoulder, and gently tap alternately.

3. Accessing Cranial Nerves

Engaging the cranial nerves can help to activate the social engagement system, promoting a sense of safety (Levine, 1997, 2010).

Practical steps:

• The vooo sound: Inhale deeply and exhale while making a ‘vooo’ sound, stimulating the vagus nerve (Levine, 1997, 2010).
• Valsalva manoeuvre: Inhale, hold the breath, and blow out with a closed mouth and nose. This helps to reset the heart rate.

4. Breathwork

Controlled breathing exercises help to regulate the autonomic nervous system.

Practical step:

• Box breathing: Inhale for a count of four, hold for four, exhale for four, and hold again for four. Repeat this cycle.

5. Movement

Physical movement can help to dissipate excess energy and bring clients back to the present. Encouraging clients to move – whether rocking, swaying or walking – can help to dissipate excess adrenaline and cortisol. Movement allows clients to process their mobilised state and to return to calm.

Practical step:

• Encourage clients to stand up, walk around, or perform simple movements (e.g. rocking or swaying) to help in releasing tension.

6. Co-Regulation

Creating a safe, calm presence in the therapy room can help clients to feel more secure. Through co-regulation, therapists can provide a calming presence for clients.

Practical step:

• Maintain a calm demeanour and practise self-regulation techniques to model and promote a sense of safety for clients.

Final Remarks

Trauma-informed grounding techniques are essential tools for counsellors and psychotherapists. By understanding the body’s response to trauma and applying tailored grounding methods, therapists can help clients to reconnect with the present and feel safer within themselves.

These techniques, grounded in theories such as the polyvagal theory, offer practical ways to support clients in their healing journey. It is crucial to practise these techniques with clients, explain their purpose, and adapt them to individual needs to ensure their effectiveness.

Trauma-informed grounding techniques can be powerful tools for healing, but they must be used with sensitivity, respect and a deep understanding of the client’s experiences. By prioritising safety, collaboration and informed consent, therapists can create a therapeutic environment where clients feel empowered to explore and heal from their trauma.

By integrating these grounding techniques into their practice, therapists can provide more holistic and effective trauma therapy, helping clients to navigate their trauma and move towards recovery.

Free Handout Download: Trauma-Informed Grounding Techniques: Essential Tools for Therapy

References and Further Reading

Dana, D. (2018). The Polyvagal Theory in Therapy: Engaging the Rhythm of Regulation. New York: Norton.

Dana, D. (2020). Polyvagal Exercises for Safety and Connection: 50 Client-Centered Practices. New York: Norton.

Hoffman Institute. (n.d.). Trauma, resilience and addiction: Hoffman interviews Dr Gabor Maté [online]. Hoffman Institute. [Viewed 3/7/24]. Available from: https://www.hoffmaninstitute.co.uk/trauma-resilience-and-addiction-hoffman-interviews-dr-gabor-mate/

Levine, P. (1997). Waking the Tiger: Healing Trauma. Berkeley: North Atlantic.

Levine, P. (2010). In an Unspoken Voice: How the Body Releases Trauma and Restores Goodness. Berkeley: North Atlantic.

Maté, G. (2018). In the Realm of Hungry Ghosts: Close Encounters with Addiction. London: Vermilion.

Porges, S. (2017). The Pocket Guide to the Polyvagal Theory: The Transformative Power of Feeling Safe. New York: Norton.

Rosenberg, S. (2017). Accessing the Healing Power of the Vagus Nerve: Self-Help Exercises for Anxiety, Depression, Trauma, and Autism. Berkeley: North Atlantic.

Schwartz, A. (2020). The Post Traumatic Growth Guidebook: Practical Mind-Body Tools to Heal Trauma, Foster Resilience and Awaken Your Potential. Eau Claire: PESI.

van der Kolk, B. (2015). The Body Keeps the Score: Mind, Brain and Body in the Transformation of Trauma. New York: Penguin.

These works provide a deeper understanding of trauma and its impact on the body, offering additional techniques and insights for effective therapy.