The Bottom-up Approach
When it comes to the so-called top-down approach in psychotherapy and art therapy, I guess every therapist knows how it works. The process involves primarily the explicit memory systems in the right brain-hemisphere. These are focused on autobiographical memories, events that happened, and dreams – and in art therapy the images that are created in association with such events and memories. Occasionally the recall or the insights will trigger emotions and some therapists will even pay attention to body-posture and movements, but for most of the session the therapy will rely on verbal communication and the cognitive understanding of the process.
In recent years the call for a bottom-up approach has become stronger. Neurologists, psychiatrists and trauma specialists such as Bruce Perry, Bessel van der Kolk, Babette Rothschild, Iain McGilchrist and others emphasise that complex trauma, which has its origin in adverse experiences in early childhood, also physical, emotional, sexual and medical trauma do not respond well to talking therapies. These are experiences that are held in the implicit memory systems of our body and clients often do not have the words to name what is going on.
Implicit memory is stored in the brainstem, which is the seat of our ancient survival system. This is the part of our brain that deals with trauma, however, it does this in a predominantly body-based way. The brainstem is strongly influenced by attraction and repulsion. It is being informed through repeated action patterns, such as learning to walk, to ride a bike, or to put a spoon into our mouth. Once we have mastered an action pattern, it becomes part of our implicit memory system and we do not ever think about it, unless someone pushes us into a pool of water when we never had learnt to swim, or an accident no longer allows us to move a limb. In the same way we do not think about breathing, making our heart beat or our muscles to contract and relax.
The next ‘higher’ limbic system is also called our emotional brain. It is in many ways just as much beyond our conscious control. Grief, anger, joy, fear, surprise and disgust can be powerfully compelling. We may think we are in charge, until something happens which overwhelms us. (Levine 2015, p 17)
Only at around the age of six children begin to have a language that allows them to tell a story, yet we know that the most formative experiences in childhood are likely to happen at a much younger age. Sexual trauma is primarily non-verbal, and so is the experience of accidents, followed frequently by medical procedures, where the client was anesthetised, and yet, the body remembers. However, these memories often don’t have a story to tell. Rather they may make themselves known as inner tension, restlessness, and sleeplessness, or as having no energy, feeling tired, collapsed and the need to sleep all day long. Emotional pain that cannot be communicated may manifest as physical pain, even illness – or erupt as rage and grief.
Having trained as a Somatic Experiencing therapist with Peter Levine, I have learnt how to work with implicit body memories. I had practised Guided Drawing and Clay Field Therapy for decades and knew, it was effective as a Sensorimotor Art Therapy approach, however, only now was I given a language to communicate what I was doing. In effect my maturing as a therapist was bottom-up as well.
If we look at the bottom-up approach in the context of the Expressive Therapies Continuum, a session begins with the Kinesthetic/Sensory Level. The focus in Guided Drawing is then on rhythmic repetition of motor impulses according to the experience of physiological tension and pain. Sensing resonance in the body, will lead to massage movements executed as motor impulses. In Work at the Clay Field undifferentiated motor impulses are expressed through touching the clay and molding it. Often this initially follows learnt biographical action patterns. It reflects the way we learnt to touch and being touched in relationships and how we were taught to handle the world.
Gradually the Perceptual/ Affective Level becomes activated. Now we can direct motor impulses with intent; we can apply archetypal shapes in Guided Drawing to orient and to affect change. We gain inner orientation. The felt sense reveals its encoded emotions and allows us to express affect through colors, shape and movement. This is still non-figurative and primarily non-verbal. We may splash red color onto the page and scratch it with our finger nails, or strangle a lump of clay in rage. Or, we may tentatively take a hand-full and feel, what it is like “to have lots”.
Until gradually, and often only toward the end of a session the Cognitive/Symbolic Level allows us to link the language of implicit memory to conscious, autobiographic events. Only now the the symbolic expression of color, shape, movement and intended direction may reveal its meaning. We gain the ability to make sense of the felt sense in the body. Based on experience, we may now look at updating old belief systems.
The bottom-up approach from the perspective of the client may initially feel like: "I have no idea what I am doing here, but I keep repeating this shape just as I feel it in my body." “To touch this feels strange, disgusting, scary and yet I want to touch it.” on the Kinesthetic/Sensory Level. Once it comes to the Perceptual/ Affective Level, this may sound like: "I notice how this movement resonates in my body. I feel better now." Frequently only towards the end of the session clients will gain insight into: "Finally I understand why I have been acting like this." But also, they may now be able to question long-held beliefs about themselves. “I feel powerful” can be the end of identifying as a victim. “I am safe to feel my heart” may facilitate the transition from being in shut-down and denial. These are insights based on a felt sense; they have emerged from an embodied inner knowing, and not from cognitive insights. Such embodied patterns of being are being remembered as a gut-felt knowing of who I am.
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