The issues that bring you to therapy, and your current level of functioning, will influence the therapeutic approach that is best for you.  To make this determination, it is helpful to distinguish between “top-down” approaches and “bottom-up” approaches. 

Top-down approaches are what we typically see in “talk therapy.”  These rely on the neocortex (the outer part of the brain – what makes us human – sometimes called the upstairs brain) and emphasize logic, problem solving, and language.  Top-down approaches include Cognitive-Behavioral Therapy (CBT),  Solution Focused Therapy, and Narrative Therapy, to name a few.  These therapies tend to rely on strategies and techniques, often include homework, and rely on the neocortex (logic and language) to attempt to manage one’s emotions (housed in the downstairs brain). 

In contrast, the downstairs brain is more primitive (includes the mammalian brain and reptilian brain) and is responsible for regulating our emotions and bodily functions, including our fight, flight, and freeze responses.  Bottom-up approaches, including EMDR Therapy, Natural Processing, and other body or emotion focused therapies, work with the downstairs brain to bring healing and change, resulting in neurological shifts within the client. Most of the work is done in the therapy session, and this work tends to be more emotionally intense than the work done with top-down approaches.  While this fact makes these therapies uncomfortable for some people, it is this deep work that tends to result in healing and lasting changes, versus learning how to cope with or manage emotions.

The upstairs brain and downstairs brain work together much like a teeter-totter.  When emotions are high and the body is activated (downstairs brain is high on the teeter totter), logic and language do not function at their best (upstairs brain is low on the teeter totter).  We can see evidence of this with a functional MRI, but we don’t need science to prove that when someone is really worked up, they become less rational and reasonable.  Thus, top-down approaches work well when the issues are not highly disturbing, but for more distressing matters, bottom-up approaches may be a better fit, as we may not be able to successfully access our upstairs brain.  Your therapist will discuss options with you and together you will choose the approach that best suits you and your needs.