Most sites in this business have no incentive to write this page. Here it’s anyway, because a recommendation is only worth something if it can also be withheld.
When something else is more urgent
If you’re in danger from yourself or someone else, that comes first and it isn’t a somatic question. Call or text 988. If you’re in an abusive situation, individual therapy of any kind isn’t the intervention — safety planning is, and a domestic violence advocate will be more use than any of this.
If you aren’t eating, or not sleeping at all, or losing weight fast, or drinking to function, those need addressing directly. They also make this work largely impossible, because a system that’s starving or in withdrawal can’t do the regulation the method depends on.
When a medical answer hasn’t been ruled out
Fatigue, palpitations, dizziness, gut trouble, numbness, chest tightness. All of these are things somatic therapists see constantly and all of them have medical causes worth excluding first. Thyroid, anaemia, sleep apnoea, cardiac, neurological. Get the workup. A responsible practitioner will ask whether you’ve had one.
When a structured treatment hasn’t been tried
If you’ve OCD, exposure and response prevention is the treatment with the most behind it and it’s very often not offered. If you’ve a specific phobia, or panic with a clear trigger, targeted CBT works quickly and well. If you’ve PTSD from a discrete event and have never tried a trauma-focused protocol, trying one is reasonable.
This site has argued elsewhere that the word evidence-based carries more weight than it should. That argument is about calibration, not dismissal — it isn’t a reason to skip a treatment that has helped a great many people.
When the fit is wrong
If interoceptive attention makes things reliably worse — and for some people, particularly some autistic people and some people with health anxiety, it does — that’s real and it isn’t resistance. Turning attention inward isn’t neutral for everyone.
If you’ve tried it for a few months with a well-trained practitioner and nothing outside the room has changed, that’s data. Say so, and let them help you find the thing that fits better. Anyone competent would rather that than keep you.
When you can’t afford it
Weekly private sessions for a year is a large amount of money, and doing it on a credit card while your finances deteriorate isn’t a neutral act. Community mental health, training clinics, group therapy and a good book are all real options, and some of them are better than a private practitioner you can only see twice.