Comments on: The Difference Between ‘Top-Down’ and ‘Bottom-Up’ Therapy, and Why It Matters https://cptsdfoundation.org/2022/08/02/the-difference-between-top-down-and-bottom-up-therapy-and-why-it-matters/ The Foundation for Post-Traumatic Healing and Complex Trauma Research Fri, 31 Oct 2025 13:52:17 +0000 hourly 1 https://wordpress.org/?v=6.9.4 By: Tanzi https://cptsdfoundation.org/2022/08/02/the-difference-between-top-down-and-bottom-up-therapy-and-why-it-matters/#comment-43946 Fri, 31 Oct 2025 13:52:17 +0000 https://cptsdfoundation.org/?p=242536#comment-43946 In reply to Paul Babbitt.

Are we twins from across the world 🫣 I hear you!

]]> By: Elisabetta https://cptsdfoundation.org/2022/08/02/the-difference-between-top-down-and-bottom-up-therapy-and-why-it-matters/#comment-34217 Fri, 23 May 2025 16:48:22 +0000 https://cptsdfoundation.org/?p=242536#comment-34217 Thank you for your article.
I felt the same too with a couple of therapist.
I left the room worse than I had entered it.

]]> By: Dr. Susan G Simpson https://cptsdfoundation.org/2022/08/02/the-difference-between-top-down-and-bottom-up-therapy-and-why-it-matters/#comment-25702 Thu, 23 May 2024 06:41:56 +0000 https://cptsdfoundation.org/?p=242536#comment-25702 In reply to Peggy.

Please add Schema Therapy to your list of bottom up approaches 🙂

]]> By: Jessica T https://cptsdfoundation.org/2022/08/02/the-difference-between-top-down-and-bottom-up-therapy-and-why-it-matters/#comment-16815 Fri, 26 Aug 2022 04:15:05 +0000 https://cptsdfoundation.org/?p=242536#comment-16815 In reply to Paul Babbitt.

Me too. Sorta. I am so sick of the platitudes. A year and a half of therapy so far, just turning 52. Still feel alone. Successful at everything I attempted – until my brain/body just quit. I just couldn’t stuff it down and perform any longer. And that itself caused debilitating shame/failure. My “friends” and peers scattered – hoping they didn’t “catch” whatever “disease” it was I had. Others are happy to “fix” me. Everything I “know” is being redefined/reframed. I’m seriously overqualified but finally working again (after nearly 4 years) at a dead-end hourly job instead of the mentally challenging work I crave but am afraid to attempt – yet. Just cannot yet manage the depression spirals, sudden bouts of tears, and panic attacks. It IS better though – I CAN function well enough to get out of bed/bathe/dress/drive/work – and usually all in the same day – lol! I haven’t been threatened with being fired since Feb! AND I am still functioning though I was sexually assaulted by someone I trusted just 3 weeks ago. I have SOME resilience again! (There were a few days though…)

Paul, You are worth the risk, worth being known fully. Thanks for sharing. It was good for me.

]]> By: Heidi Fischer https://cptsdfoundation.org/2022/08/02/the-difference-between-top-down-and-bottom-up-therapy-and-why-it-matters/#comment-16725 Mon, 15 Aug 2022 18:51:21 +0000 https://cptsdfoundation.org/?p=242536#comment-16725 In reply to Paul Babbitt.

Thank-you for sharing your experience with us and I totally empathize with what you are saying. You are doing such hard and important internal work – I hope you can feel some pride in that and recognize that change happens slowly…but it does happen! I’m glad my writing is useful for you and I love hearing that you’ll share it in therapy. I wish you well on your path, you are doing great things!

]]> By: Paul Babbitt https://cptsdfoundation.org/2022/08/02/the-difference-between-top-down-and-bottom-up-therapy-and-why-it-matters/#comment-16715 Sat, 13 Aug 2022 20:58:40 +0000 https://cptsdfoundation.org/?p=242536#comment-16715 Heidi,

At least I know that the part of my brain constantly concerned with presenting well has not enjoyed much success.

When my therapist returns from maternity leave, will share you’re fab blog & the wonderful websites.

Turned down a nice dinner invite tonight because I felt like I was depressed and too worried about presenting well. It hurts so much to keep failing to connect well.

I’ve had a devoted Kundalini yoga practice for 23 years, regular acupuncture for the same, & serious bouts of writing my innermost thoughts & feelings.

Ironically my intuition led me there. For I only was diagnosed with childhood PTSD 8 years ago at age 56. Always knew there was something up because of having a paranoid schizophrenic Mother, and a rejecting emotional unavailable Father.

Haven’t shared in a meaningful way with other survivors, nor shared my story. My frustration at not being able to get EMDR or MDMA therapy. The pain of being 64, suffering rejections, and behavioral tips from others. Oh like thanks, never occurred to me, duh. Been trying all of my life.

The inverse is I am over educated, successfully self employed, live in a dream house in Boston and am well connected within many communities. Like looking out of a fishbowl. Alone in my success.
Alone in my failure.

]]> By: Heidi Fischer https://cptsdfoundation.org/2022/08/02/the-difference-between-top-down-and-bottom-up-therapy-and-why-it-matters/#comment-16691 Wed, 10 Aug 2022 18:45:11 +0000 https://cptsdfoundation.org/?p=242536#comment-16691 In reply to Peggy.

I’m really glad that my writing found you and that you found it validating! I know when I first heard about this it made so much sense to me, and really helped me understand why some things had not been helpful. All the best to you on your journey.

]]> By: Peggy https://cptsdfoundation.org/2022/08/02/the-difference-between-top-down-and-bottom-up-therapy-and-why-it-matters/#comment-16683 Tue, 09 Aug 2022 16:53:24 +0000 https://cptsdfoundation.org/?p=242536#comment-16683 I am grateful for your article. It validated my experience in therapy. I also appreciate including that some therapist utilize a foot in both areas. I have made the biggest advances when I became aware of the bottom up process. Now I utilize both. I still have a lot of work to do. I think for me, your cartoon acknowledged where I became stuck…I felt no one believed me when I was introduced to the top to bottom method. It being a brain process helps a lot, too. Takes away the black and white thinking of either or.
It is funny, I was in a group recently and mentioned this bottom up process. I really had no idea they were concepts in therapy. I appreciate your validating article.

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