What is the ‘Bottom-Up’ Approach in Therapy?

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If you haven’t considered counselling or psychotherapy before, you might be surprised to learn that it actually is very a diverse discipline. There is no ‘one size fits all’ approach. Instead, it helps to think about it like pizza. Sounds strange, but stay with me.

If you’re sitting around with ten friends, and you order pizza, you are probably going to end up ordering a range of different varieties and flavours. It’s the same with counselling and psychotherapy. There are many different flavours and styles out there. It’s the job of your counsellor to meet with you, understand your needs and match the best approach to address your specific needs.

So this post will explain a bit more about the ‘bottom-up’ approach to therapy. And also how it is different from the widely used ‘top-down’ one.

Why do we need two approaches in the first place?

Our brain is similar to a hugely complex computer. It continuously processes data received from inside and outside our body. There are two main reasons behind this: keeping us safe and making us thrive.

In order to operate smoothly our brain uses different regions to perform specific tasks. Some of the data processing work goes on subconsciously. However, we are consciously aware of other activities in our brain and mind. Just think about the effort you put into logical thinking or recalling information when you sat for your last exam.

The top-down approach to therapy focuses on functions that are executed in the upper regions of the brain such as thinking, speaking and our moment-to-moment emotional awareness. The counsellor who prefers top-down modalities focuses on how a client mind is interpreting information. More like those conscious functions we mentioned above. The aim of top-down interventions is to help clients change their negative thoughts. During such therapy, for example Cognitive Behavioural Therapy (CBT), clients learn ways to ‘think right’ so they can feel right and then make better choices of behaviour.

However, researchers have found that the logic-based approaches only work in limited ways. Although for some people it is possible to ‘catch’ and change their thoughts, there are many who don’t respond to treatments like these.

For people who had traumatic experiences or had difficult or abusive upbringing, the thinking brain region with its logical functions is less active as for those who can respond to stress without becoming emotionally overwhelmed. The response to trauma down-regulates the thinking areas and sends energy to the regions of the brain that are involved with feelings and sensations. People with trauma histories need therapy that facilitates connecting to these areas safely.

What is the bottom-up approach?

The bottom-up approach to therapy refers to the type of therapy that starts its work with the ‘base’ of the brain. This refers to the part of the brain that is responsible for automatic reflexes and survival (like your ‘fight, flight or freeze’ response). Interestingly, This part of the brain stores certain types of memories too.

The starting point for this type of counselling is acknowledging that feelings such as a sense of discomfort or fear occur before a conscious thought takes place. This is what we refer to as the ‘gut feel’ or ‘intuition’ and scientists call it implicit memory. Clients can learn to mindfully map what is happening in their body during the safety of a counselling session and notice how it is reflected in their emotions when painful issues surface. The ‘thinking brain’ is switched on once trust has been built during therapy and the client’s nervous system feels safe.

A trauma informed bottom-up approach allows clients to dig deeper than their thoughts, explore their feelings and make sense of their emotions. 

How Does the Bottom-Up Approach Work?

The bottom-up approach works because it recognises that feelings, such as fear or sadness, can bubble up and affect a person before they have a conscious thought about them. 

What really helps people with trauma or attachment issues is to start noticing the feeling that triggers the thinking. Bottom-up interventions such as Sensorimotor Psychotherapy, EMDR (Eye Movement Desensitisation and Reprocessing), and others integrate the brain. So that to start with, one notices what their body senses when triggered. At the same time knows that it reacts to something that had happened in the past. The integrated brain can conclude “I’m safe now, I am just remembering”.

The benefits of bottom-up approaches

One of the strongest benefits of bottom-up therapies is that clients learn to be ok with different previously unmanageable, uncomfortable feelings without becoming overwhelmed. They acquire skills to tolerate and respond to them without wanting to block or numb the discomfort. The increased awareness of their range of responses can also help clients better understand what their particular triggers are. Then successfully navigate on their journey towards resolving those triggers and live a fulfilling life.

Anita Balogh of Swan Counselling uses trauma-sensitive bottom-up approach to assist her clients, along with a range of other methods. Clients can experience this tailored approach to counselling with cutting-edge therapies in a comfortable and caring environment in Peregian Springs on Queensland’s Sunshine Coast. If you’d like to arrange an appointment, contact us today.


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30 Lakeside Dr, Peregian Springs QLD 4573

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