Top-down vs bottom-up in psychotherapy: body and mind

You learn life lessons that are unconsciously embedded in your nervous system. A form of therapy that focuses not only on the cognitive (top-down) but on the body experience (bottom-up) is more likely to help you work on the patterns and life lessons that have settled in your body. Therefore, it can be important to consider top-down vs bottom-up in psychotherapy. 

Top-down vs bottom-up in psychotherapy: There are many different types of psychotherapy, each with their own contribution. Psychotherapy can be understood as either top-down, bottom-up or a mixture. Traditionally, therapy has been either top-down or bottom-up. Throughout life, we build up a lot of life lessons from situations where we had to adapt. Maybe we've learned "my needs are not as important as other people's needs" or "it's not ok to make mistakes". Such life lessons may be appropriate in some contexts or have been very meaningful earlier in life, but can now be a hindrance to living a good life. A life lesson can settle in the body (nervous system) so that we unconsciously live out these life lessons; they are a kind of basic life strategy. For example, if I have learned that I should put my own needs aside, I may not realize that I have this life strategy and not fully understand why it is difficult for me to have a joyful life with others.

It can be difficult for top-down therapies to really get a grip on an inappropriate life lesson that has been stored in the body, meaning that we unconsciously act based on this life lesson. A top-down therapy deals with volitional thoughts (cognition) as these affect the body's emotional and instinctive system. Conversely, it can also be difficult for a bottom-up therapy to fully address the issue. Bottom-up therapy focuses on the body's sensations and instinctive responses, i.e. the focus is on the involuntary and unconscious actions and regulations of the nervous system.

In reality, there is a constant flow of information from the brain to the body and from the body to the brain that can reinforce each other. You may cognitively (top-down) understand that it is inappropriate to always override your own needs, but if your nervous system is poorly regulated and "takes over" in certain situations based on your early learned life strategy, you may feel that your conscious intentions are of little use. That's why it's also important to work on creating body contact and practicing nervous system regulation.

Psychotherapy will typically uncover which life lessons are interfering with your life today. By also practicing connection with your body, it becomes easier for the client to distinguish between what is true and what is false in the personal narrative. Life lessons and trauma occur bottom-up, not top-down.

Top-down vs bottom-up in psychotherapy

Bottom-up therapy: Starting from the body experience (Brainstem) with subsequent influence on the limbic system (emotions) and neocontex (thoughts)
Top-down therapy: Starting from the thoughts (neocortex) with subsequent influence on the limbic system (emotions) and brainstem (body experience).

Source: "Developmental trauma - How developmental trauma affects self-regulation, self-image and the ability to connect" by Laurence S. Heller of Aline LaPierre (2014)