Not All Therapy Feels the Same: Top-Down vs Bottom-Up Therapy Explained Simply
Top-down! Bottom-up! Person-centered! Psychodynamic! Jungian! Solution Focussed! Walk and talk! You might have come across many different types of therapy and wondered what they mean, what the differences are, and which one might be right for you.
Some therapies focus predominantly on talking things through.
Others focus more on feelings and what’s happening in your body.
It can feel a bit confusing, and possibly overwhelming, especially when all you really want is to find something that helps you in the moment.
The truth is, there isn’t just one way to do therapy. There isn’t one ‘right’ way either. It’s about finding the best option for you.
There are two major branches of therapy:
Speaking very broadly, there are two roads most people choose between when considering therapy.
Talking and Understanding
This is the kind of therapy most people are familiar with.
We talk things through.
We make sense of thoughts, patterns, and experiences.
We begin to understand why we might feel or react in certain ways.
We might learn coping strategies and alternative ways of reacting.
Talking therapies can be really helpful for gaining clarity and insight.
Feeling and Experiencing
Sometimes, and for many people, talking isn’t easy.
You might not be ready to say the words out loud, you might not even know exactly what’s causing you to feel the way you do presently.
You might understand why you feel a certain way, but your body still reacts as if something isn’t quite safe.
This is where a more body-aware approach can help.
Instead of focusing only on thoughts, we gently pay attention to:
- how experiences are held in your body
- physical sensations
- emotional responses
- how your nervous system (including the vagal nerve) responds
- how to resource, increase your tolerance and resilience
Top-down & Bottom-up: What do these mean?
You might have heard these two approaches described as:
- Top-down (starting with thoughts and understanding)
- Bottom-up (starting with feelings and the body)
Basically, these describe two ways of approaching counselling and therapy.
Top-down: Sometimes we begin with talking. Working cognitively, exploring verbally what’s happening, along with your goals and wishes.
Bottom-up: Sometimes we begin with noticing how things feel inside. Racing heart, shallow breath, feelings of anxiety. We don’t need to discuss the activating event/s, just how thinking about it shows up in your body.
Often, in session, it’s a mixture of both.
Does it matter which therapeutic approach I choose?
Not everyone experiences things in the same way.
It’s great to be able to try different approaches and choose the one you feel most aligned to.
You might feel comfortable talking and reflecting.
Or you may:
- struggle to find the right words
- feel overwhelmed without knowing why
- notice things more in your body than your thoughts
Occasionally, talking on its own doesn’t quite reach the deeper layers of what’s going on. That doesn’t mean therapy isn’t working, but that exploring an alternative approach might be helpful, especially if you are ‘stuck’.
I keep hearing about somatic therapy…what is this?
You may have come across the word somatic.
Somatic is a term you may be hearing more often at the moment.
The word ‘soma’ comes from the Greek, meaning ‘of the body’. In therapy, it’s simply about what’s happening in your body alongside your thoughts and experiences.
Rather than only talking about what’s happened, we can also gently notice how those experiences are held physically within you, whether that’s tension, restlessness, heaviness, or something harder to describe.
With my background in hands-on therapies, I’ve always been interested and intrigued by how closely the body and mind are connected. My somatic work builds on this understanding in a calm, steady, and professional way.
Somatic therapy sounds right up my street! Where can I find a somatic therapist?
A quick internet search will help you find a qualified therapist.
As always, do speak with a few people to ensure you find one you feel is the right fit for you.
Alongside talking therapy, I work somatically with trauma. This means, whichever approach you originally feel is best for you, I can introduce gentle somatic awareness into sessions where it feels appropriate, or if working somatically feels too much at times, we can change to working cognitively.
Working somatically might include:
- noticing physical responses to thoughts or situations
- slowing things down so feelings can be recognised safely
- helping you reconnect with a sense of calm in your body
Like every therapy approach, somatic work is always done at your pace, and only if it feels comfortable for you. As always, you are in charge of your session, we can work in whichever way you are most comfortable.
A gentle, flexible approach
In my work, I don’t believe one approach fits everyone. What feels perfect one day may feel completely wrong during another session.
Some sessions you may feel more like talking things through and benefit more from this approach, others you may want to delve into your body further and be aware of your feelings or physical responses.
Additionally, we might use creative approaches if words and feelings seem difficult and you are drawn towards an alternative approach.
We always start with what feels most comfortable for you, moving at a pace that feels manageable.
I’m not sure where to start or which therapeutic approach to choose
You don’t need to understand all of these approaches before starting therapy.
You don’t need the right words.
You don’t need a clear plan.
You just need a sense that something feels difficult, or unsettled.
From there, we can work together to find an approach that feels right for you.
I feel as though my body needs a reset!
I’m presently working on a hands-on, somatic-based offering, that will gently support the connection between your body and mind, helping to calm and reset your nervous system in a safe and professional setting.
It will bring together my counselling work and my years of hands-on therapeutic experience, offering a more integrated approach for those who feel they would benefit from it.
If you’d like to be the first to know when this new therapeutic treatment is live, please do let me know by clicking here.
If you feel we might be a good fit for you and would like to take the next step:
If you’d like to explore whether Lorraine’s Counselling, Somatics and Wellbeing feels like the right space for you, you’re very welcome to book a free 15-minute discovery call.
Click here to book your discovery call



