How does Play Therapy work? A bottom-up approach

by Laura Rosenberg, Play Therapy Hub

Parents often ask, ‘how will play therapy help my child?’ The answer is simple. Play therapy helps children get to the root of the issue. Play therapy is a bottom-up and inside-out approach to psychotherapy.

When we talk about approaches to bottom-up and top-down play therapy, we are referring to the parts of the brain that the therapy is focused on. Top-down therapy is focused on starting therapy with the higher parts of the brain – the parts of the brain responsible for logic, thinking and reasoning.

Bottom-up therapy, however, starts therapy with the lower parts of the brain – the parts of the brain responsible for memories, reflexes and the body’s internal alarm system. This is also the place where traumatic and challenging memories are stored.

Top-down Play Therapy

So, which approach is best? Top-down approaches to therapy are focused on identifying problematic thoughts. When using this approach “what is wrong with your thinking and how do we fix it?” is often asked. Top-down approaches can help individuals to identify the way their mind is interpreting information. It does not, however, always get to the root of the issue. In a way, top-down therapy can sometimes minimise the gravity of a difficult experience or dismiss the significance of an individual’s emotional state. Top-down therapy can sometimes ask the individual to simply ‘think their way out of it’.

Bottom-up Play Therapy

Bottom-up approaches, however, start with noticing and understanding feelings and body sensations first. Play therapists understand that states of dysregulation – uncontrollable thoughts and behaviours.

They often come about when a child feels unsafe. This is particularly true for children who have had traumatic or challenging experiences. Such feelings of unsafety are stored deep within the lower parts of the brain and in the body.

So, rather than telling the child not to be scared (focusing on thoughts in the top part of the brain), the play therapist first focuses on addressing feelings and body sensations. To soothe the body and let the brain’s internal alarm system know that the danger has passed. This uses  the bottom part of the brain.

One way that bottom-up play therapists do this is by establishing a deep-felt sense of safety for the child client. We do this providing the child client with a predictable, responsive, nurturing and respectful therapeutic relationship.

From here, the play therapist can then help the child to increase awareness of what’s taking place in their own body. Noticing, for example, the child’s tensed muscles, racing heartbeat or laboured breathing.

Regulating sensations in their own body

The therapist also models how to name and regulate sensations in their own body. Thus giving the child the opportunity to learn by observation. Helping the child to understand the way in which they can check in with their body sensations to make sense of their internal world.

By increasing self-awareness of body sensations and emotions, the play therapist can then help the child to explore both their feelings and their thoughts. This allows the child to experience and integrate feelings of insight, as well as safety in the body and in the mind. This is where the healing takes place.

Finally, bottom-up approaches like play therapy are highly effective for children. As children are better equipped to ‘play out’ their experiences, rather than ‘talk things through’.

Bottom-up approaches to therapy provide opportunities for dual-awareness of both thoughts and feelings. Shifting the focus from mind-over-matter to mind-and-body awareness. With a bottom-up approach, play therapy asks the child, “what happened to you?”. Rather than, “what’s wrong with you?”. Play therapy integrates whole-of-brain, whole-of-body and whole-of-child approaches to promote regulation and healing. Play therapy gets to the root of the issue.

TRF is excited to present Play-Based Healing: Establishing Safe Connections featuring Margaret Blaustein, Lou Bergholz, and Dafna Lender on October 29th! To learn more and register, click here!

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