These are the brain stem areas responsible for reflexes, memories, and automatic survival responses. When we talk about the bottom-up approach, we’re talking about starting therapy with the parts of the brain located toward the base. These are the topmost areas of the brain, and include the neocortex, frontal lobes and prefrontal lobes. When we talk about a top-down approach, we’re focused on starting therapy with the parts of the brain we associate with thinking, speaking, and current emotional awareness. Different parts of the brain work together to help us use information to survive and thrive in the world. The terms top-down and bottom-up refer to the general areas of the brain and where you start in therapy (from the top or the bottom). What Does Top-Down and Bottom-Up Therapy Refer To? Here’s why I believe a bottom-up approach is so valuable, especially for trauma survivors. It’s important for those who have and treat trauma to know the differences between a bottom-up and top-down approach.

In my experience, it is the best all-encompassing approach to help create healing, and lasting change in a person’s ability to think, feel, and find healthier ways to live after trauma. One thing I can say for sure is that, in my experience, a bottom-up approach to therapy works better in trauma-informed care.

Because there is never a one-size-fits-all approach, I integrate many therapeutic approaches into my work with clients. There are numerous approaches to psychotherapy.

Bottom up processing