Top-Down and Bottom-Up
Psychotherapy approaches are grouped into two main orientations: top-down and bottom-up.
Top-down approaches—cognitive-behavioral therapy, psychoanalytic therapy, talk therapy—work through language, meaning, beliefs, and cognition. Thoughts change, meaning is reframed, and relationship patterns are made visible through discussion.
Bottom-up approaches—somatic experiencing, sensorimotor psychotherapy, EMDR, Hakomi—work through bodily states, movement, breath, and physiological regulation. The body comes first; meaning and verbal processing follow.
Bessel van der Kolk’s book The Body Keeps the Score (2014) clarified this distinction in the context of trauma. Traumatic experiences may not enter the language system—the Broca’s area (speech production) can become deactivated during the retelling of a trauma narrative. In such cases, accessing that experience through speech becomes difficult. Bottom-up approaches open a different door to overcome this obstacle.
Peter Levine’s Somatic Experiencing
Peter Levine developed the Somatic Experiencing approach (Waking the Tiger, 1997) based on observations of animal behavior. The central observation: animals complete their stress response after a threat through trembling, shaking, and movement. Humans often block this completion.
Somatic Experiencing aims to access these uncompleted responses through the body. The core practice involves directing attention to bodily signals in the therapy room, recognizing somatic completion cues—such as slight trembling or fluctuations in body temperature—and creating a safe space for this process to unfold.
When Talk Therapy Isn’t Enough
Talk therapy is effective in many situations. But it has its limitations in certain cases:
When the experience is inaccessible through language: “I don’t know what I felt; something is just happening in my body”—in this case, there is no raw material for conversation.
If physical reactions persist despite a shift in thought: one may be understanding, yet the heart rate is still elevated; one may be rational, yet the stomach is still in knots. The implicit memory system remains unaffected by cognitive processing.
In the presence of dissociation: when the connection to the body is severed, talk therapy may remain superficial.
Somatic Awareness-Based Coaching: A Different Approach
Somatic therapy is a clinical intervention. Somatic awareness-based coaching, however, is development-focused—aiming to integrate bodily signals into decision-making, performance, and self-awareness.
The two serve different purposes, and this distinction must be maintained. Coaching is not for clinical symptoms; it is for unlocking developmental potential.
“Trauma is experienced without language. Its treatment often begins without language as well.” > Bessel van der Kolk, The Body Keeps the Score, 2014
Cevvela’s Perspective
- Top-down (verbal) and bottom-up (somatic) approaches operate through different mechanisms—they are not rivals but complementary.
- Traumatic experiences may not enter the language system; in such cases, bottom-up approaches are critical (van der Kolk, 2014).
- Somatic experiencing aims to access unresolved stress responses through the body (Levine, 1997).
- Somatic therapy is a clinical intervention; somatic awareness-based coaching is development-focused—this distinction is important and must be maintained.
- Cevvela uses somatic awareness tools in a coaching context—it is not a clinical intervention.
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