What is Trauma-Informed Therapy?
In my initial therapy session as an adult, I shared a detailed account of my history and childhood traumas. The psychologist listened quietly, occasionally nodding. However, I left feeling distressed, like I'd opened a Pandora’s box I couldn't close. I never went back.
Over the years, I learned that the psychologist didn't work to establish a sense of safety or containment. While it felt good to be heard, her approach wasn't trauma-informed.
So, what's the difference between “top-down” and “bottom-up” therapy, and why does it matter?
Firstly, "top" and "bottom" refer to different brain sections.
Traditionally, therapy followed a top-down approach, focusing on thinking, speaking, and present-day emotions—working cognitively with thought patterns, communication, decision-making, and problem-solving. It aims to change thoughts, assuming that thinking “right” will make everything okay.
On the other hand, the bottom brain section deals with memories, impulses, and survival responses. Bottom-up therapy targets sensations, educates on the nervous system, and promotes mindfulness and body awareness.
The new school of thought suggests bottom-up approaches, especially for trauma, challenging top-down methods. Top-down often assumes adjusting thinking solves issues, overlooking the automatic nature of the nervous system, wired to perceive danger. Top-down methods, such as cognitive-behaviour therapy, often don’t work well for people with a history of trauma because it presupposes what needs adjusting is the person’s way of thinking. As a result, many therapy clients end up feeling like something is intrinsically wrong with them.
A top-down approach is saying, “Let’s just think about it differently. Let’s think ourselves out of it.” However, trauma triggers the body first, then the mind. Peter Levine emphasises you can't process thoughts if your body screams danger.
“Top-down methods, such as cognitive-behaviour therapy, often don’t work well for people with a history of trauma because it presupposes what needs adjusting is the person’s way of thinking”
If you’ve tried therapy before without success, a bottom-up approach might benefit you. It delves into brain stem areas, responsible for reflexes, memories, and survival responses. In bottom-up therapy, merely feeling trauma-charged emotions isn't enough; you need to do something with them, as just feeling the emotions without action can be re-traumatising.
Trauma-informed bottom-up therapy lets you explore dysregulated feelings after safety and stabilisation are built and felt. It allows dual awareness—feeling the past and being present.
A bottom-up approach asks: “What happened to you?”
This process helps you realise the danger you're responding to is old, fostering a sense of safety for your younger self. The frontal lobe needs to integrate with the lower brain to make sense of feelings.
Trauma diverts energy to the primal brain. For those with trauma, thinking can't override the primal brain's response. The body's memories of danger, supercharged by the amygdala, take precedence over calmly thinking things through.
Both top-down and bottom-up approaches have validity, and in reality, most therapists use some type of a blend of the two.
If you've resonated with the insights shared here and are ready to engage in therapy, I invite you to reach out. Let's explore how a bottom-up approach to therapy can provide the support and understanding you need evoke change.