What Is Bottom-Up Therapy?
A Holistic Path to Healing for Adult Children of Emotionally Immature Parents, Children of Immigrants, and BIPOC Neurodivergent Individuals
Choosing Therapy That Honors Your Whole Self
Therapy is becoming more accessible and less stigmatized, and that’s a beautiful shift. But with so many practitioners and the alphabet soup of modalities available, it’s easy to feel overwhelmed. If you’ve ever wondered, “Why didn’t therapy work for me?” or “Is there a deeper way to heal?”, you’re not alone.
Understanding the difference between therapy approaches can help you become an active shaper of your healing journey. And it is your healing journey, not anyone else’s. Particularly for those navigating relational trauma, cultural identity, and neurodivergence, choosing a therapist who works bottom-up, not just top-down, can be life-changing.
TL;DR
Bottom-up therapy focuses on healing through the body, nervous system, and authentic connection, rather than just thoughts and behaviors. For adult children of emotionally immature parents, neurodivergent individuals, and BIPOC or children of immigrants, modalities like EMDR, Somatic IFS, and psychodynamic therapy offer deeper transformation than traditional talk therapy. This blog explores why top-down approaches often fall short — and how bottom-up therapy can help you feel seen, regulated, and truly changed.
Top-Down vs. Bottom-Up Therapy: What’s the Difference?
Top-down therapy focuses on thoughts, logic, and behavior. Modalities like CBT (Cognitive Behavioral Therapy) and DBT (Dialectical Behavior Therapy) aim to change how you think so you can change how you feel. These approaches engage the prefrontal cortex—the brain’s reasoning center. In top-down models, change is conscious, deliberate. Change is “forced” or strongarmed.
Bottom-up therapy, on the other hand, starts with the body, emotions, and implicit memory. It works with the brainstem and limbic system, where trauma responses live. Modalities like EMDR, Somatic IFS, and psychodynamic therapy help clients access healing through sensation, emotion, and relational depth.
This distinction emerged from neuroscience and trauma research, especially the work of pioneers like Bessel van der Kolk, Stephen Porges. Their findings show that trauma is stored in the body, and so healing must include the body. Therapists such as Janina Fisher, Pat Ogden, and Susan McConnell developed methods and frameworks that brought the research to life for clients.
For adult children of emotionally immature parents, children of immigrants, and BIPOC or neurodivergent individuals, bottom-up therapy offers:
A culturally attuned, holistic therapy experience
Relief from chronic dysregulation and emotional looping
A way to heal trauma that words alone can’t reach
While bottom-up modalities powerful change that go beyond what cognitive and behavioral therapies offer, it’s important to respect the strengths of top-down therapies. Cognitive-based change does speak to the reality that our thoughts, beliefs, and cognitive perceptions do influence our sensations, emotions, and behaviors. And behavioral-based change does speak to the reality that until we act differently, situations will stay the same. I believe bottom-up therapies shine when we have made all the conscious effort to gain insight and make changes in our thinking and behavior patterns and still need a deeper relief.
Four Frustrating Experiences in Top-Down Therapy
“I understand my patterns, but I still feel stuck.”
You may relate to this if you’re the kind of person who finds safety, meaning, power, and control in knowledge and understanding, but struggles to translate that safety and power into your overall life.“I know what I should do, but I freeze or shut down.”
Maybe you relate to this one because you’ve had difficulty affording therapy and needed to rely on self-help before taking on the financial risk of therapy. Education is very helpful but can only go so far without relational or somatic change.“I feel like I’m performing in therapy instead of being real.”
Presenting as a “good enough” client is common in people who needed to adapt to major relationships by hiding imperfections that would have been punished. While being acceptable helped you navigate many things in the best possible way, it’s not possible to hide parts of yourself forever.“I keep looping in the same stories without feeling relief.”
Finally, looping in stories may be something you relate to because, without realizing, the negative stories give you a sense of control over your life in that you’re always able to understand why things often end up a certain bad way. As satisfying or predictable as it may be to know how the story always ends, disempowering narratives can trap you further in.
Whatever your reason for finding the limits of top-down therapy may be, these frustrations are common, and they don’t have to be the end of your story. These walls may be signs that your nervous system needs a different kind of care. Here are three bottom-up therapy modalities that complement each other well.
Psychodynamic Therapy: Depth and Insight
Psychodynamic therapy explores unconscious patterns, attachment wounds, and early relational experiences. The therapist listens deeply, reflects, and helps you make meaning of your inner world.
What the therapist does: Holds space for emotional exploration, interprets unconscious material, and builds a secure relational container.
What the client experiences: Insight, emotional validation, and a growing sense of self-awareness.
Best for: Attachment trauma, identity development, and relational wounds.
How it helps:
Offers insight into why you feel stuck, but not in a way where you’re being talked at/explained – the therapist will help you link persistent patterns
Validates emotional blocks and defenses without reinforcing them – the therapist will gently bring mindfulness to and clarify intrapsychic or interpersonal defenses you use in real time
Encourages authenticity over performance – the therapist knows how to notice masks and won’t rip it off you but rather bring mindfulness to it
Helps you understand the roots of your looping stories – through working out your repetition compulsion
Somatic IFS: Healing Through Parts and the Body
Somatic IFS (Internal Family Systems with somatic elements) helps you connect with your internal “parts”—protective, wounded, and wise—and relate to them with compassion. It integrates body awareness, allowing you to feel and unblend from trauma responses.
What the therapist does: Guides you to notice sensations, meet your parts, and access Self energy.
What the client experiences: Emotional clarity, nervous system regulation, and deep inner connection.
Best for: Complex trauma, identity fragmentation (feeling unsure of who you are and what you want), and chronic dysregulation.
How it helps:
Moves stuck parts through embodied awareness – therapist will know when to cut the analysis and get the stuck sensation moving
Supports regulation when you freeze or shut down – you won’t be forced out of it, but gently working to expand the capacity to “feel” frozen and shut down, to be embodied within these states, and to slowly thaw freeze responses
Creates space for realness and vulnerability – the therapist will share their authentic self as they arise with you in the therapy room, so you’re not doing it alone with another “fake” human
Resolves emotional loops through felt connection – whether it’s in connecting estranged parts of yourself with each other, or with another human being feeling alongside you
EMDR: Reprocessing Trauma for Lasting Change
EMDR (Eye Movement Desensitization and Reprocessing) uses bilateral stimulation to support memory reconsolidation. It helps you reprocess traumatic memories so they no longer feel overwhelming.
What the therapist does: Facilitates reprocessing using eye movements, tapping, or sound.
What the client experiences: Emotional release, nervous system shifts, and cognitive clarity.
Best for: PTSD, complex trauma, memory reprocessing, breaking conditioned responses, and neurodivergent clients who need felt relief more than cognitive relief.
How it helps:
Releases stuck trauma responses – the therapist works with you to identify a persistent stuck point that you will work through with bilateral stimulation
Bypasses cognitive blocks and supports regulation
Accesses deeper emotional truths without over-talking AND without being reliant on the therapist to “give” you an insight that you could access within yourself
Creates lasting shifts in how memories are stored – you’ll remember what happened without it activating you
How These Modalities Work Together
A progressive therapy plan might look like this:
Psychodynamic Therapy to build insight, safety, and relational trust
Somatic IFS to deepen body awareness and heal internal parts
EMDR to reprocess core traumas and transform implicit memory
Together, these bottom-up modalities offer a holistic therapy experience—one that honors your mind, body, and story.
Choose Therapy That Transforms You
You deserve therapy that doesn’t just explain your pain, but transforms it. A competent therapist will know how to weave together modalities that complement each other, because no single approach can do it all.
If you’re ready to take a leap of faith and work with someone who won’t settle for surface-level healing, I invite you to schedule a consultation. Let’s bring consciousness to your unique patterns and gently rewrite them from the inside out.
About the Author
Chelsea Adams, LPC is a licensed therapist with over 7 years of experience supporting clients in their mental wellness. She specializes in intergenerational, relational, religious, and systemic trauma and uses a decolonized model of evidence-based approaches such as EMDR, Somatic Internal Family Systems, Psychodynamic Psychotherapy, and therapy intensives to help clients connect to their own wisdom, voice, and power. Chelsea is committed to providing compassionate, expert care online for clients across Pennsylvania.
