Why Bottom-Up Therapy?
When healing starts in the body, not just the mind
In the therapy world, you might hear people talk about top-down and bottom-up approaches.
Top-down methods, like CBT, start with the thinking brain — helping us notice and reshape thoughts, beliefs, and stories. They can be immensely helpful for understanding patterns and building skills for coping day-to-day.
Bottom-up therapies, on the other hand, start with the body. They focus on sensation, breath, and the nervous system — the places where so much of our lived experience resides. Instead of trying to “think our way” into safety, they help the body feel it again.
Why start with the body?
When something painful or overwhelming happens, it doesn’t just live in our minds — it imprints itself in our muscles, breath, and heartbeat. As Bessel van der Kolk writes, “The body keeps the score: it stores what the mind cannot.”
Even long after the danger has passed, our nervous system can stay braced for threat. We might feel jumpy, disconnected, or stuck in patterns we can’t quite explain. Bottom-up therapy helps us meet those sensations directly, with curiosity instead of fear.
Peter Levine, who developed Somatic Experiencing, reminds us that “Trauma is not what happens to us, but what we hold inside in the absence of an empathetic witness.”
By slowing down and listening to the body’s signals — tension, breath, fluttering, or stillness — we begin to release what’s been held too long without support. Healing happens not by erasing the story, but by letting the body know it’s finally safe to relax.
The gifts of going bottom-up
Working this way takes time. Bottom-up therapies move at the pace of the body — which is often slower than the mind wants. But that slowness is part of their power. It allows the nervous system to build safety and trust from the inside out.
It reaches what words can’t. Some experiences are pre-verbal or beyond language. Starting with sensation allows healing to begin even when words feel impossible.
It supports real regulation. Bottom-up work helps reset the nervous system, not just the thoughts that sit on top of it. Over time, people often describe feeling calmer, clearer, and more at home in their bodies.
It builds lasting change. Rather than managing symptoms, this approach helps re-wire the brain’s pathways for safety, connection, and ease.
Francine Shapiro, the founder of EMDR, described this process as the brain “resuming its natural healing ability” once the blocks caused by trauma are cleared. In other words: when we stop fighting the body and start listening to it, the system knows how to find balance again.
The hard parts (and why they’re worth it)
Because bottom-up work follows the body’s rhythms, progress can sometimes feel slower or less linear. We might spend time learning to track sensations or simply notice what happens when we pause — before diving into memories or meanings.
Gabor Maté writes, “Safety is not the absence of threat, but the presence of connection.” That’s what bottom-up therapy is ultimately about: re-building connection — with our bodies, with others, and with parts of ourselves that had to go quiet to survive.
It can be frustrating when it doesn’t move as quickly as a cognitive or skills-based approach. But the pace is intentional. Healing trauma isn’t about forcing insight; it’s about helping every layer of us know we are safe enough to integrate what was once too much.
In the end
Bottom-up therapy isn’t “better” than top-down approaches — they simply work in different directions. Sometimes, they even meet in the middle.
In my work, I often integrate somatic, EMDR, and Internal Family Systems (IFS)-informed approaches, weaving together body awareness, gentle processing, and compassionate curiosity toward all parts of ourselves.
For people who have spent years trying to understand their pain without much relief, starting with the body can be a gentle doorway back to self-trust.
The body remembers. And with the right kind of support, it also knows how to remember its way back to safety.
About the Author: Breanna Thompson is a registered therapist who integrates EMDR, somatic, and Internal Family Systems (IFS)-informed approaches to support trauma healing, embodiment, and reconnection. With a background of living and working internationally, she offers therapy to clients in Canada and abroad, helping them find safety within themselves and nurture a more compassionate relationship with their inner world.