Top Down (Talk Therapy) vs. Bottom Up Approaches (Somatic Therapy) To Therapy
Top Down Therapy
Top down refers to traditional therapy that focuses on the top of our bodies (our head/brain)
Focuses on our thoughts first and then the sensations, feelings, and emotions
Teaches coping skills, provides psychoeducation, etc.
Examples include: talk therapy, Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), etc.
Sample top down questions:
What were you thinking about before you….?
When you have these thoughts of X, what do you tend to do next?
Bottom Up Therapy
Bottom up refers to bodily or somatic therapy that focuses on the bottom half of our bodies
Focuses on tension, stress, sensations that are usually unresolved and releasing them through fully processing them
Examples include: Somatic experiencing, Sensorimotor Psychotherapy, EMDR, etc.
Sample bottom up questions/statements:
Where do you feel that in or around your body?
As you talk about what happened, I want you to notice how you feel inside of your body, if that’s okay….
When you were talking about X, I noticed your shoulders tensed up….
Did you notice your lip was quivering when you were discussing X…?
See if it would be okay to just notice your fingers in the moment….just look at them with curiosity….
What would it be like to just be curious about what’s going on with the tension in your chest…would you be open to that?
Which One Is Better?
No one approach is better per se
We need both because people are complex
Some people need one or the other, while others need a blend of both
It also depends on what you are seeking therapy for (e.g. a single issue, management of symptoms, wanting to focus on early childhood issues, etc.)
It also depends on who your therapist is in terms of training, skill, experience as well as how comfortable you feel sitting with them (therapeutic relationship, trust, comfort, etc.)
Research & Evidence
Somatic therapies like Somatic Experiencing and Sensorimotor Psychotherapy are still being studied to see of its efficacy while traditional talk therapies like CBT, ACT, etc. are well studied and have robust evidence that they work for, generally for most of the population through Randomized Controlled Trials (RCT), though not for everyone
However, there are many reasons why somatic therapies do not have more robust studies including: expenses/money/funding, difficulty measuring quantitive data due to the bodily/somatic experience, etc.
Read My Other Blog Posts on Somatic Therapy & Trauma