Understanding Top-Down and Bottom-Up Approaches in Psychotherapy

What are Top-Down and Bottom-Up Approaches in Therapy

Maybe you've heard the terms 'Top-down' and 'Bottom-up' used in relation to psychotherapeutic approaches, and perhaps you've been wondering what they mean and what the difference is between them? I've written this blog to offer an understanding into both approaches, how they can be used, and how each benefit you on your therapy journey.

We can start with the understanding that each approach uses interventions that engage different parts of your brain. This means that using a combination of both Top-Down and Bottom-Up interventions has the benefit of inviting a holistic, and whole person approach to therapy.

Let's look at Top-Down interventions

Top-down psychotherapeutic interventions engage the upper brain centres in the neocortex, and focus on working with your thoughts and beliefs.

An example of a Top-Down therapy modality is Cognitive Behavioural Therapy (CBT) which recognises that our thoughts and beliefs can influence our emotions and behaviours. Using a CBT approach in therapy can support you in identifying negative and positive beliefs as well as challenging thinking errors.

Mindfulness, psychoeducation, talk therapy, resourcing interventions such as grounding exercises and some forms of conscious breathing are all further examples of Top-Down interventions. They are effective in supporting you to:

• Gain insight and expand your self-awareness.

• Understand and change your thought patterns.

• Create new meaning making on a cognitive/narrative level.

• Develop more effective beliefs and resourcing behaviours.

• Make conscious choices in your everyday life.

Since Top-Down approaches engage the upper brain centres, they don't access the parts of the brain where the emotional and sensory components of your experiences are held. This means they are less effective in the processing of emotions, somatic and implicit material.

What are Bottom-Up interventions about?

Bottom-up interventions in psychotherapy focus on working with the body, its sensations and emotions, and they do that through engaging the lower brain centres in the limbic system and brain stem to help you access the emotional and sensory components of your experiences.

Working this way accelerates the emotional processing of material. In contrast to Top-Down interventions where the work in on a cognitive level, bottom up interventions invite you to feel and integrate whatever was unsafe for you feel at the time of originally experiencing it.

This process allows for suppressed and un-expressed emotions, sensations, physical movement sequences and compromised survival defence mechanisms to be attended to, completed and/or renegotiated so that energy can move through your body and the activation is discharged on a physiological level. This is what effectively resets your nervous system and allows it to regain optimal flexibility. Bottom-Up interventions include body-based psychotherapies such as; Somatic Experiencing, Sensorimotor Psychotherapy, Hakomi Method, Authentic Movement and Integrative Body Psychotherapy

Working in this way also supports you in developing somatic intelligence so that you are no longer overriding and/or disconnecting from your body, as well as guiding you to effectively embodying the change(s) you want to make; it takes you on a journey of transformation from the inside outwards.

The Importance of integrating Both Approaches

As a holistic integrative psychotherapist, I recognise that our physiology and psychology are interlinked. I also recognise the importance of inviting both mind and body into therapy sessions for a whole person approach which honours the bidirectional relationship between the body and the brain. I am a great advocate of inviting clients to become nervous system aware, and gain an understanding of how what they carry on a physiological level and within their autonomic nervous system, impacts their cognitive story.

Many people are cognitively aware of how they want things to be different and may often have the insight of knowing what needs to change within themselves to feel and live how they would prefer, but here's the thing; cognitively knowing all of this is not enough for your body to believe it. If you are operating from survival mode consciously or unconsciously and your nervous system is in chronic dysregulation, then attempting to work on changing your thoughts before your body is feeling safe and open enough to receive such change can result in frustration and sometimes even more pain for you:

"Why is nothing happening? Why am I still doing this/being this way when I KNOW what needs to change and I want a different outcome?"

This is where psychoeducation on the neurobiology of your being (a Top-Down intervention), combined working somatically (a Bottom-Up intervention), invites opportunity for you to connect consciously with your autonomic story, and empowers you in your processing of the 'felt' components of your material.

Working in this way is going to support you in making the implicit explicit and make way for healing at the core. This frees your nervous system to open up to new ways of being because it is no longer working so hard to protect you from re-experiencing your past. You will then feel less threatened to adopt new thoughts and beliefs, you will get to experience a deeper level of healing and personal growth, and you will create more alignment within your mind and body.

In Conclusion

You are a whole person, and my invite to you is for us to work with the whole of your experience. I use both Top-Down and Bottom-Up approaches to enrich the therapy experience in a way that empowers you to become an agent of change in your process, which I personally believe, may be the most transformative thing a person can do for themselves.

A question for you:

Having read what you've read, what are you noticing within yourself? Your thoughts, emotions, your breath and any other bodily sensations or intuitive feelings?

I invite you to take a note of what you've noticed, and if it feels comfortable for you to do so, get curious about what's showing up for you. You know this is very much the way I work; an invitation to explore and get curious about your experience(s), and if this is something you feel you'd like to find out more about, I invite you to click the button below to schedule your free 15 minute discovery call for me where you can ask your questions about the process.