Sensorimotor Psychotherapy and Cognitive Processing Therapy: A Comparison

Introduction

When healing from trauma, it’s crucial to find therapeutic approaches that align with your unique needs and experiences. For those in the trans* and queer community, this often involves looking beyond traditional modalities to find inclusive and effective methods that affirm your identity. Trauma can affect many aspects of your life and sense of self, and these effects can be compounded by discrimination, exclusion, or violence specific to your identities. Therapies that recognize and work within these contexts are essential. In this blog post, we explore two evidence-based trauma therapies—Sensorimotor Psychotherapy (SP) and Cognitive Processing Therapy (CPT). Each offers distinct pathways to healing, and understanding these approaches can help you make informed decisions about which modality might best support your journey.

Overview of Trauma Therapy

Trauma therapy has evolved significantly, incorporating diverse methods to address trauma’s complex impacts on both the mind and body. Both CPT and SP are recognized as effective trauma-focused therapies, yet they differ in their foundational approaches and techniques.

Cognitive Processing Therapy (CPT) is a cognitive-behavioural approach that helps you examine and challenge unhelpful thoughts and beliefs stemming from traumatic experiences. It is structured and focuses on modifying “Stuck Points”—beliefs that keep you trapped in cycles of distress—through cognitive restructuring and exercises like Impact Statements and ABC Worksheets. This method encourages you to explore how trauma has affected your thoughts and beliefs and how altering these can change your emotional and behavioural responses.

Sensorimotor Psychotherapy (SP) takes a more holistic approach, integrating cognitive, emotional, and somatic (body-based) experiences to address trauma’s profound impact. SP focuses on the body’s role in trauma recovery, acknowledging that trauma is not only stored in the mind but also in the body. It encourages you to reconnect with your body and develop a sense of safety through mindfulness and body-based techniques. SP can be especially helpful if you have complex trauma, dissociative symptoms, or need a non-verbal, body-centred approach to processing trauma.

Key Concepts in Each Approach

Cognitive Processing Therapy (CPT):

•Structured Cognitive Approach: CPT is highly structured, typically comprising 12 sessions aimed at helping you understand the relationship between thoughts, emotions, and behaviours. Activities like writing Impact Statements to describe how trauma has affected you and using ABC Worksheets to identify “Stuck Points”—cognitive distortions or unhelpful beliefs—help break down complex emotional responses. These tools provide clarity on where your thoughts may be inaccurate or unhelpful.

•Key Techniques:

•Socratic Questioning: A guided discussion method that helps you examine your beliefs to find evidence that supports or contradicts them. This can be particularly powerful for trans* and queer clients who need to challenge internalized narratives stemming from societal oppression.

•ABC Worksheets: These worksheets help you understand the relationship between Activating events, Beliefs, and Consequences, allowing for an in-depth exploration of how specific thoughts contribute to emotional distress.

•Alternative Thoughts Worksheet: This tool encourages you to practice generating more balanced thoughts and beliefs, which can be a valuable exercise in building resilience against internalized stigma and discrimination.

•Strengths and Suitability: CPT is particularly effective if you are comfortable with structured, verbal processing and cognitive exercises. It is well-suited for those ready to engage directly with their trauma memories and thoughts. However, it may be less suitable if you experience high levels of dissociation or have difficulty articulating your experiences in a linear fashion, which is common among those who have experienced multiple traumas or ongoing traumatic stress.

Sensorimotor Psychotherapy (SP):

•Body-Based and Holistic Approach: SP goes beyond cognitive processing by integrating somatic awareness into therapy. It focuses on how trauma is stored not only in the mind but also in the body, affecting physiological responses and body memories (Ogden, Minton, & Pain, 2006). This method can help you better understand how your body holds onto trauma and how you can begin to release these physical manifestations. For many trans* and queer clients, whose bodies may have been sites of conflict or discomfort, SP provides a way to gently reconnect with your body in affirming ways.

•Phased Approach to Healing: SP generally involves several phases, starting with stabilization and resource-building. This is crucial for managing your autonomic nervous system responses—such as hyperarousal or dissociation—before moving into deeper processing of traumatic memories. The initial phase focuses on creating safety and establishing a sense of agency in your body, allowing you to build trust and readiness for deeper work. Subsequent phases involve processing traumatic memories and integrating new, more adaptive responses to triggers.

•Emphasis on Readiness and Safety: Unlike CPT, which often involves processing trauma memories early on, SP emphasizes the importance of being fully prepared before engaging in deeper work. Techniques like grounding exercises, mindfulness, and body awareness help you regulate your nervous system and develop a stronger foundation for processing trauma. This is particularly helpful if you have complex trauma, ongoing trauma, or a fraught relationship with your body, as it allows you to approach therapy at a pace that feels safe and sustainable.

How Each Modality Impacts Healing

Working within an anti-oppressive framework, particularly with trans* and queer clients, requires a deep understanding of how different therapeutic modalities can support diverse healing experiences. As a therapist, recognizing the unique challenges that Two Spirit, trans, nonbinary, and queer clients face allows for more responsive and affirming care. Both CPT and SP offer distinct advantages when tailored to address the intersecting identities and lived experiences of marginalized communities.

Applying CPT in a Gender-Affirming Context:

CPT can be highly effective in helping you, as a therapist, support clients in challenging internalized narratives shaped by trauma, such as experiences of transphobia, homophobia, or other forms of systemic oppression. By working through structured exercises like Impact Statements or the ABC Worksheets, you can guide clients to explore and reframe deeply ingrained beliefs about themselves and the world. This is particularly valuable for clients who have experienced minority stress or discrimination, where cognitive distortions like self-blame or feelings of unworthiness can be prevalent. For example, a nonbinary client facing persistent misgendering might use CPT to challenge the belief that they are “invisible” or “invalid” in society, gradually shifting these harmful narratives.

However, it’s essential to approach CPT with flexibility. Some clients, especially those with complex trauma or dissociative symptoms, may find its cognitive focus challenging if they are not yet ready to engage fully with the trauma cognitively. In such cases, starting with safety and stabilization work is crucial to build a foundation for more intensive cognitive work later on.

Integrating SP for Body-Inclusive Healing:

Sensorimotor Psychotherapy offers a different but complementary pathway by focusing on the body’s role in trauma processing and recovery. This modality can be particularly impactful for clients who have a complex relationship with their body, such as those experiencing body dysphoria, or those who find verbal processing difficult or overwhelming. SP emphasizes the development of mindfulness and awareness of bodily sensations, which can help clients build a sense of safety and grounding. For clients who have experienced ongoing trauma or are in environments that still feel unsafe, the body-based focus of SP allows them to explore trauma in a controlled and gradual manner. This is especially important for Two Spirit, trans, and nonbinary clients who may have developed disconnection or avoidance behaviours related to their bodies.

For instance, a client named RJ, a trans woman, may struggle with hypervigilance triggered by street harassment. Using SP techniques like grounding exercises, breathwork, or safe place visualizations, RJ could learn to regulate her nervous system responses, helping her manage and eventually reduce her heightened anxiety in public spaces. These tools empower clients to reconnect with their bodies in affirming ways and build resilience against ongoing stressors.

Supporting You in Choosing the Right Modality

Understanding the distinctions between CPT and SP is essential whether you are a therapist seeking to expand your therapeutic toolbox or a client looking for a gender-affirming approach to trauma therapy. Each modality offers unique strengths and potential benefits:

•For Therapists: Incorporating both CPT and SP can enrich your practice by allowing for more tailored and flexible approaches to client care. You might use CPT’s structured cognitive exercises to help clients address distorted thoughts while integrating SP’s somatic techniques to promote grounding and bodily awareness. This dual approach is valuable for clients who may need to shift between cognitive and somatic processing to manage their trauma symptoms effectively.

•For Clients: Knowing the differences between these therapies can guide you in selecting a therapy that feels right for you. If you find comfort in structured, thought-based exercises and are looking to challenge your beliefs directly, CPT might be a good fit. Alternatively, if you feel drawn to exploring how trauma impacts your body and want to build a sense of safety and control through bodily awareness and movement, SP may provide a more resonant path.

Work with a Certified Sensorimotor Psychotherapist

If you are interested in exploring Sensorimotor Psychotherapy with a certified practitioner who understands the unique needs of trans* and queer clients, I invite you to join my waitlist. Working with me, you can experience an approach that honours both the cognitive and somatic aspects of your trauma, providing a comprehensive path to healing. Bookmark this blog and check back for more insights on how SP and other trauma-informed therapies can support you in reclaiming your life. I invite you to join the waitlist.

Conclusion

Both Sensorimotor Psychotherapy (SP) and Cognitive Processing Therapy (CPT) provide valuable and distinct pathways to trauma healing, each with unique strengths that can support different aspects of the therapeutic process. Understanding the benefits and limitations of each modality can help you, whether as a therapist or a client, make an informed decision about the best approach for your needs.

CPT offers a structured, evidence-based method that is particularly effective for addressing distorted thoughts and beliefs stemming from trauma. Its clear framework is helpful for clients who are ready to engage in cognitive work and examine their trauma-related thoughts to develop healthier, more adaptive beliefs. For therapists, CPT provides a reliable structure to guide clients through challenging cognitive processes. However, it’s important to recognize when clients may need a more flexible or gradual approach, especially if they experience high levels of dissociation or emotional overwhelm. In these situations, building foundational skills around safety and stabilization is essential before moving into cognitive restructuring.

SP, in contrast, offers a holistic, body-centred approach that integrates the mind and body in trauma recovery. This modality acknowledges that trauma is not only stored in the mind but also manifests in the body, affecting physiological responses and emotional states. SP can be especially beneficial for clients in the trans* and queer community who may have a complex relationship with their bodies. It provides a more gentle, affirming way to reconnect with oneself, allowing for deeper emotional and somatic processing and helping clients develop a sense of agency and safety within their bodies. For therapists, SP encourages a flexible, client-centred approach that can be tailored to meet clients where they are in their healing journey, ensuring they feel supported and empowered throughout the process.

Whatever path you choose for your healing journey, may it be the one that resonates most deeply with you and brings the comfort, growth, and understanding you seek. As a Certified Sensorimotor Psychotherapist who also incorporates Cognitive Processing Therapy when it’s the right fit, I’m here to support you in finding the approach that aligns best with your needs. If you feel ready to explore these therapeutic options with a practitioner who understands the unique experiences of the trans* and queer community, I invite you to join my waitlist and bookmark this blog for more insights, updates, and resources on inclusive, affirming therapy practices.

References

Resick, P. A., Monson, C. M., & Chard, K. M. (2017). Cognitive Processing Therapy for PTSD: A Comprehensive Manual. The Guilford Press.

Ogden, P., Minton, K., & Pain, C. (2006). Trauma and the Body: A Sensorimotor Approach to Psychotherapy. W. W. Norton & Company.