Why Choose Bottom-Up Therapies

Many people by now have heard of Bessel Van Der Kolk’s bestseller, The Body Keeps the Score, which is one of the more well-known books out there discussing the impact that trauma has on the body, and thus, how including the body in mental health treatment is vital for trauma recovery. Prior to that, most therapies were either behavioral, where it looked similar to dog training in a way, or were insight-based. While insight is still notably important and useful, it often doesn’t relieve the symptoms. Van De Kolk said it well when referring to a patient of his who helped him recognize the significant ties between trauma and the body, “… understanding the source of the impulse made no difference in helping her control it.”

This is why I often encourage going to a therapist well trained in bottom-up therapies, or at least therapies that include an experiential or somatic components.

Top-down therapies, which focus more on thoughts and often leave out the bodily experience, include those like:

• Cognitive Behavioral Therapy (CBT)

• Dialectical Behavioral Therapy (DBT)

• Cognitive Processing Therapy (CPT)

• Prolonged Exposure Therapy (PE)

• Solution-Focused Brief Therapy (SFBT)

Whereas bottom-up therapies that incorporate the body and encourage a felt experience, include:

• Eye-Movement Desensitization and Reprocessing Therapy (EMDR)

• Accelerated Resolution Therapy (ART)

• Internal Family Systems Therapy (IFS)

• Somatic Experiencing (SE)

• Brainspotting

• Sandtray therapies

• Emotionally Focused Therapy (EFT)

• Neuroaffective Relational Model (NARM)

Most therapists are trained in top-down therapies in graduate school, and this is what most people will experience when they go to therapy. Some people definitely benefit from those approaches, there is no doubt about that, but there are many people who do not because their struggle is felt within the body, and insight isn’t enough to change the way that they feel. I myself use mainly ART, IFS, EFT, and Sandtray therapies in my work, because I see how vital it is to include the body when healing. You can’t think yourself out of trauma! Many of us may not recognize the traumas we have, because they seemed like “normal” experiences, and it was many small moments put together. However, if you look closely enough with a trauma lens, it is easy to see how many feelings or behaviors usually started as a way to avoid a pain or internal belief about oneself or the world that we picked up a long time ago.

“… understanding the source of the impulse made no difference in helping her control it.”

~ The Body Keeps the Score, by Bessel Van Der Kolk