Top-Down and Bottom-Up Approaches in Therapy:

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Why Play Therapy May Be a Better Fit for Your Child

Top-down and bottom-up refers to the parts of the brain that are being used in therapy to process information. Top-down processing uses the ‘top’ parts of the brain, the frontal lobes and pre-frontal cortex, and relies heavily on language, reason, and logic. Top-down therapy approaches tend to focus on changing the way we think, to change how we feel. Top-down approaches also rely on an individual’s ability to remember and then apply strategies in the future. Examples of top-down approaches include changing the way a stressful situation is interpreted, replacing negative thoughts with positive ones, or counting to 10 and walking away when upset, instead of hitting.

One of the challenges of top-down therapy approaches is that those parts of the brain are actually the last to develop – they’re typically not fully developed until 25-30 years of age. This means that, for children and adolescents specifically, it can be difficult to use top-down processing consistently and effectively, especially in challenging situations. 

Bottom-up processing uses the lower regions of the brain to process sensory and emotional information. These parts of the brain include the brain stem and the limbic system and are more developed at birth. They are also responsible for storing our memories, our automatic reflexes, and our body’s internal alarm system. Bottom-up therapy approaches start with learning to pay attention to sensory information within the body (for example, feelings and body sensations) to then re-pattern how the nervous system responds to those signals. Nervous system dysregulation is often the underlying cause of many behavioural issues, and this dysregulation is often due to memories that are being stored in the lower parts of the brain and body. When we feel threatened or unsafe, these deep memories can come out as uncontrollable thoughts and behaviour – for example, ‘meltdowns’ or ‘blow-ups’.

Children primarily communicate through play, so play therapy emphasizes play, instead of talking, to help a child explore their emotional memories. This is a bottom-up approach. When a child is immersed in any kind of play, or art, the child is relying on  the lower regions of their brain. In this state, the child can more effectively learn to notice and name what is happening in their body in the moment, compared with talking about emotions from a neutral state out of context. For example, helping a child to recognize what anger feels like in their body first (bottom-up) instead of talking about anger and learning what to do when they are angry/scared (top-down). Once a child learns what anger feels like in their body, they are then supported with learning new and different ways of working through those challenging emotions, as they occur in that moment. This process supports the brain with re-wiring neural pathways and is often faster and more effective in the long-term than using a just a top-down approach.

If you have further questions about play therapy or think play therapy would be a good fit for your child, you can contact at (403) 245-5981 or simply schedule an intake call by going to


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