Go with the flow
Healthcare Counselling and Psychotherapy Journal, July 2026

Most therapists will recognise the pattern: a client arrives for their weekly session and spends the first fifteen minutes rebuilding psychological scaffolding, leaving only a narrow therapeutic window until the time is up. It’s not a failure of therapy; it’s a limitation of the traditional format.

Over the past decade, I have been developing an approach that attempts to address this issue. The Resurface Method™ is a five-day intensive retreat programme, integrating surf therapy, eye movement desensitisation and reprocessing (EMDR), trauma-sensitive yoga, psychoeducation and structured rest, delivered in coastal settings in Morocco, Costa Rica and the UK.

What makes the model distinctive is the deliberate sequencing of physical challenge and flow-state induction before therapeutic processing. Our research suggests this sequencing fundamentally alters the conditions under which therapy takes place. Of course, practitioners in healthcare settings might never run a surf retreat. But I believe we can all integrate elements of flow science into our existing practice.

Trauma, particularly complex and developmental trauma, is stored not only in narrative memory but in the body. Bessel van der Kolk’s influential work established that traumatic experience is encoded somatically, in muscle tension, breathing patterns and autonomic nervous system dysregulation.¹ Talking therapy addresses the cognitive and narrative dimensions but can struggle to reach what is held below conscious articulation.

There is also the question of pace. Many clients require twenty or more sessions of trauma-focused therapy to achieve clinically meaningful change, with dropout rates of twenty to thirty-six per cent.² Intensive therapy formats – multiple sessions over consecutive days – have emerged as a response, with evidence supporting comparable outcomes alongside lower dropout.³ The Resurface Method™ builds on this intensive model, adding the deliberate engineering of flow states as a precondition for therapeutic work.

Flow states

Flow, as described by Mihaly Csikszentmihalyi, is an optimal state of consciousness, which is characterised by complete absorption, loss of self-consciousness and time dilation.⁴ It occurs when challenge is well matched to skill. During flow, there is evidence of transient changes in prefrontal cortex activity, alongside the release of dopamine, norepinephrine, endorphins, anandamide and serotonin.⁵

The flow cycle moves through four stages:

• struggle (effortful loading)
• release (letting go)
• flow itself (peak experience)
• recovery (consolidation).

Understanding this cycle has practical implications for therapeutic programme design, particularly the recovery stage, which maps directly onto the consolidation processes that are central to trauma therapy.

Flow is clinically interesting because it appears to create conditions that are directly relevant to therapy:

• heightened present-moment awareness that quiets the inner critic
• reduced self-referential processing that lowers defences
• enhanced cognitive flexibility
• neurochemical changes associated with mood elevation and social bonding.

Research from the University of Sydney found a two-hundred-and-fifty per cent increase in creative problem-solving during flow.⁶ Until recently, less attention has been paid to how these mechanisms might be harnessed clinically.

Surf therapy is defined by the International Surf Therapy Organization (ISTO) as ‘the use of surfing as a vehicle for delivering intentional, inclusive, population-specific and evidence-based therapeutic structures to promote psychological, physical and psychosocial wellbeing’.⁷

Surfing is particularly suited to inducing flow because it satisfies multiple triggers simultaneously: the ocean provides an infinitely variable challenge-skills gradient; feedback is immediate; the environment is rich in novelty and complexity, and the physical demands require deep embodiment.

There is also the ‘blue space effect’ – research demonstrates that proximity to water is associated with improved mood and reduced stress.⁸ And, critically, surfing creates shared vulnerability. Participants are out of their comfort zone together, falling off boards and being tumbled by waves. The shared physical challenge accelerates group cohesion in ways that a therapy room alone cannot.

The Resurface Method™ is built on five pillars, each sequenced to optimise therapeutic conditions.

Pillar 1: Interoception. Each day begins with heart rate variability (HRV) training and trauma-sensitive yoga, using the Trauma Center Trauma Sensitive Yoga (TCTSY) model, which was developed by David Emerson and Jenn Turner, in collaboration with Dr Bessel van der Kolk. The aim is to develop body awareness and establish safety in the body, which is essential groundwork for trauma processing.¹

Pillar 2: Psychoeducation. Structured teaching on the neurobiology of trauma, stress responses and recovery. Understanding why their nervous system responds as it does can help clients reduce shame and build agency.

Pillar 3: Flow states through surfing. We then spend two hours surfing, with instructors calibrating the challenge to each participant’s ability. No prior experience is required – beginners on small waves can access flow as readily as experienced surfers.

Pillar 4: Therapy. Group therapy and individual EMDR take place after surfing. The sequencing is deliberate: the physical fatigue, neurochemical shift and group bonding from the morning appear to create a therapeutic window of unusual depth.

Pillar 5: Consolidation. We close each day with non-sleep deep rest and HRV-supported recovery, facilitating memory consolidation and the integration of therapeutic gains.

Interpretative phenomenological analysis (IPA) of four participants led to the central clinical observation that therapy after flow-state induction is qualitatively different, a finding reinforced by quantitative data across twenty-eight participants aged twenty-two to sixty-four with mixed trauma presentations.⁹

The research identified four mechanisms. First, flow functions as a direct therapeutic experience: participants reported immediate reductions in anxiety and intrusive thoughts. The absorption required by surfing silences the ruminative inner critic.

Second, participants described markedly increased openness in group therapy following surfing. Shared vulnerability in the ocean created conditions for authentic disclosure; trust that might ordinarily take weeks to build formed within days.

Third, sessions following flow activities were faster in achieving emotional breakthroughs and could go deeper in addressing complex issues. The usual warm-up period was dramatically shortened or absent.

Fourth, physicality itself was therapeutically significant. Fatigue lowered defences, fostering natural authenticity. Body engagement accessed somatically held trauma that verbal processing had not reached.

The paradox at the heart of this model is that physical challenge creates psychological safety. Shared vulnerability in the water generates the trust that enables emotional vulnerability in the therapy room.

Pre- and post-outcome analysis⁹ using standardised measures showed a twenty-nine per cent reduction in anxiety on the GAD-7. On the PHQ-9, there was a forty-nine per cent reduction in depression and a twenty-seven per cent improvement in post-traumatic growth outlook on the Changes in Outlook Questionnaire.

I want to be transparent about the research limitations: the sample is modest; there is no control group and we do not yet have long-term follow-up. But the results show clinically meaningful category shifts within five days, and the effect sizes are large enough to warrant serious attention, suggesting the need for larger controlled studies.

Implications for practice

Most readers will not run surf retreats. And you don’t have to, because the underlying principles are transferable. If trauma is stored somatically, approaches that engage the body are clinical necessities, not adjunctive luxuries. So, practitioners can incorporate movement or breathwork into their practice, or collaborate with exercise professionals to create multi-modal pathways.

Sequencing matters. Physical activity before therapy creates qualitatively different conditions. Consider recommending that clients engage in vigorous exercise before sessions and observe whether engagement shifts.

Flow can be cultivated as a clinical tool. Any activity providing challenge-skills balance, immediate feedback and full absorption can induce flow – climbing, swimming, dance, focused creative work.

Shared challenge accelerates trust. For group practitioners, introducing experiential elements could enhance cohesion and reduce the time needed to establish therapeutic safety.

To support wider application, we are developing a training programme – the Resurface Academy – to equip qualified therapists to integrate flow science, somatic approaches and intensive formats into their practice. The programme covers flow neuroscience, trauma-sensitive physical activity design, intensive EMDR delivery and outcome evaluation. It is intended not as a replacement for core therapeutic training, but as a specialist extension for experienced practitioners who want to explore intensive and experiential approaches within an evidence-based framework.

The Resurface Method™ is early in its research journey, and there is much still to learn. We need larger samples, controlled designs and long-term follow-up. But the clinical outcomes – significant symptom reduction, meaningful category shifts and participants accessing material that years of conventional therapy had not reached – suggest that integrating flow science with evidence-based therapy is worth pursuing.

I would encourage practitioners to consider where in your own work you might engage the body, create conditions for flow or use shared challenge to build trust. The ocean is not the only way in. But the principles it has taught us have something to offer every therapeutic setting.