Top-Down vs. Bottom-Up
When we think of traditional talk therapy, most of us conjure the image of a client sitting or lying on a couch talking about their problems, examining the root causes, reframing beliefs, and altering behaviors. It focuses on insight as the key to change. This is what is considered a “top-down” approach because it focuses on the “thinking” brain (the prefrontal cortex). Some examples of top-down therapy include cognitive behavior therapy, acceptance and commitment therapy, and narrative therapy, just to name a few.
There is another way to get to the “bottom” of what is keeping you stuck and that is through “bottom-up” approaches to therapy that focus on the body and nervous system, rather than the thinking mind. Trauma and chronic stress are held in the more primitive parts of the brain (the brainstem and limbic system) that operate below conscious awareness. These areas don’t respond well to logic or insight. This is why we can sometimes feel stuck because we are trying to logic and reason our way out of our problems, when instead what we need is to FEEL our way through using sensation, movement, breath, and safety cues the body can register directly. This is where Somatic Experiencing comes in.
So What Exactly Is Somatic Experiencing?
Somatic Experiencing* is a body-based therapeutic approach, developed by Dr. Peter Levine, that helps resolve symptoms of trauma and chronic stress by restoring the nervous system’s natural rhythm. SE gently guides awareness to physical sensations, images, movements, and emotions, allowing your body to release stored tension and complete incomplete stress responses. Often a result is a less reactive and more responsive and flexible nervous system.
One of the greatest benefits to SE is that it does not require the story of the traumatic experience to be retold. Oftentimes, retelling the details of our traumatic experiences can actually be retraumatizing, causing further damage. But because SE is centered in the body, we can access the story that lives there instead of reliving the details of the event.
What Somatic Experiencing Treats:
Somatic Experiencing is most commonly used for:
- Post-traumatic stress (single-incident and complex trauma)
- Chronic stress and burnout
- Anxiety and panic
- Attachment wounds
- Unresolved grief
- Difficulty regulating emotions
What Does SE Look Like in Session?
Of course this is different for every clinician and every client, but in general a session through an SE lens will involve a little less talk, and a little more space to be guided into noticing and observing your experience. A session often begins with a somatic check-in focused on small things the client can feel. It might be noticing their posture, their connection to the support of the ground or of the couch, breath, or internal sensations. Usually the focus is on something neutral or positive.
Next a client might be asked what is most present for them or what area they would like to focus on during the session. There might be some brief discussion and background information shared, but then the client is gently guided into a somatic exploration.
While the clinician is guiding, the client sets the pace. Oftentimes the first sessions are focused on psychoeducation and practice of tracking the nervous system, building a vocabulary for how to describe their experience. As the session progresses, clients often discover nervous system patterns or places of stuckness that together client and clinician explore. Sessions end with plenty of time for integration and space for clients to observe the shifts that they notice after they have done some of the work.
While this example is more SE focused, it is important to note that SE doesn’t replace top-down approaches, it complements them, and many clients benefit most from an integrated approach that draws on both.
Key Concepts of Somatic Experiencing
- Interoception: Understanding the body’s internal senses like hunger cues, constriction, temperature, tension, your heartbeat, or breath pattern.
- Exteroception: Understanding how your body detects and processes sensory information from outside your body like through your five senses.
- Resourcing: Identifying internal or external strengths, memories, or physical areas of comfort that bring a sense of safety and calm.
- Titration: Exploring small, manageable amounts of physical or emotional stress at a time so the nervous system does not become overwhelmed.
- Pendulation: Gently moving back and forth between feeling a source of stress/discomfort and a place of safety or ease in the body.
Resources Beyond The Body Keeps the Score
I often hear clients’ “gateway” book to somatic therapy is The Body Keeps the Score by Bessel Van der Kolk. While this has some good information, it is somewhat outdated with a focus on dominant culture. To expand your horizons, here are some books I’d recommend instead.
- My Grandmother’s Hands by Resmaa Menakem
- The Wisdom of Your Body by Hillary McBride
- The Body is Not an Apology by Sonya Renee Taylor
- What My Bones Know by Stephanie Foo
*A note on lineage: While Peter Levine developed and formalized SE as a clinical model starting in the 1970s, body-based approaches to healing are not new. Indigenous, African, and Asian healing traditions have a long history of understanding healing happens in the body— not just the mind. Yoga, chanting, dancing, and ancient rituals are just some examples. These healing traditions predate Western psychology by centuries, and in many cases were actively suppressed or dismissed by colonial medical systems. Levine’s contribution was to translate observations from nature and neuroscience into a structured clinical framework that could be taught and researched within Western healthcare.
We are Here to Help
If you are interested in learning more about somatic experiencing and working with the body in therapy, reach out to us using our website contact form, give us a call, or send an email to hello@kindtherapyllc.com and we’ll be in touch with you soon.
