Bottom up and top down are both common terms that you might hear in trauma treatment circles.  What does it all mean?  In the simplest language, it refers to the part of the brain stimulated by the intervention used with a client.

There are two major reasons why I believe knowing the difference between top down and bottom up interventions and modalities is important.  The first reason is it helps to identify what training and credentials to pursue based on your preferred way of working with a client. Second, it helps you to identify what types of interventions would be helpful for your clients.

My Own Journey

At the beginning of my career, there were many times I would use the “throw spaghetti at the wall and see what sticks method” of treatment.  Basically, I tried different interventions until I got success.  It wasn’t because I was being careless. It was because I didn’t understand the brain to the level that I do now.  You can’t really do effective sustainable trauma treatment without understanding the brain.  I still have a long way to go, but when I learned the basics it changed my work.  It allowed me to be strategic with the modalities and interventions I chose for my clients.   I learned to focus on what was needed to help my client get unstuck in the throes of Post Traumatic Stress Disorder symptoms.  Below I will discuss the basics of the brain, how that relates to top down and bottom up treatment approaches and why I think this is all so important in trauma treatment.

Basic of the Brain

The first thing I think we should discuss is that our brains develop from the bottom to the top.  This means that while in utero our reptilian portion, also known as the bottom part  of our brain, develops first.  This is where our automatic body functions and threat response live. The brain continues to develop into early adulthood.  The final portion to develop is the top part of the brain.  The top of the brain is called the neocortex, also know as the thinking brain. For more information on the brain visit a past blog post called, Talking With Clients About the Brain Made Easy.  You can also see a recorded demo on my Facebook page here.

How It All Fits Together

When you think about interventions or modalities that are top down they are interventions that stimulate the thinking brain first.  These are cognitive-based interventions and modalities.  I use these modalities and interventions when working with a logical person or a person who finds it easy to process information using words.

Bottom up interventions and modalities use the five senses as well as body sensations to process trauma.  I like to use these interventions when the trauma is preverbal or more chronic in nature.

In Conclusion

By no means are these the only times I use the different types of interventions and modalities, but these are just examples in hopes of helping you understand how the information all fits together.   I have learned over the years that I may lean more on bottom up modalities and interventions because they align with the way I like to work, but it is still important for me to have top down interventions in my therapy tool belt to ensure I am a well-rounded clinician.

Comment Below

Are you more of a top down or bottom up type of trauma therapist?