When Therapy Isn’t Enough: The Missing Piece in Emotional Healing

If you’ve spent hours in therapy, learned to spot your triggers, and can name your patterns — but still find yourself reacting in the same old ways — you’re not alone.

Often it’s not a lack of insight that keeps us stuck, but a missing link between what the mind understands and what the body still remembers. This is where the difference between top-down and bottom-up healing can completely change the picture.

The Top-Down Route: Starting with the Thinking Brain

Top-down approaches begin in the neocortex — the part of the brain responsible for reasoning, logic, language, and planning. They include most forms of talk therapy, counselling, and reflective coaching work — anything that starts with thought, language, or insight.

These methods help us:

• Understand our relationship patterns

• Recognise how past experiences or trauma may still shape current reactions

• Establish healthier emotional boundaries

• Strengthen self-awareness and communication

  
  

They’re powerful tools — but they rely on a nervous system that’s calm enough to think clearly. When we’re triggered, overwhelmed, or stuck in stress physiology, the rational brain often goes offline. That’s where bottom-up work comes in.

The Bottom-Up Route: Starting with the Body

Bottom-up approaches start not with thoughts, but with sensations. They focus on the body’s signals — heart rate, muscle tension, breath, posture — and help regulate the nervous system so that the thinking brain can re-engage.

Think about that familiar flutter of butterflies in your stomach before a big event, or the clenching sensation you might feel when recalling a painful memory. These are examples of the body responding before the mind has even had a chance to interpret what’s happening. Bottom-up work allows us to tune into and work with those signals directly, so they no longer run the show in the background.

Historically, we’ve been told to explore talk therapy, which is an incredible resource, but in some instances, some individuals may do better to explore a more somatic type of therapy first — one that helps restore safety in the body before diving into deeper reflection or analysis.

In neuroscience terms, bottom-up work activates pathways that travel from the body to the brain, letting your system know, “It’s safe to stand down.” Only once that safety message has been received can reflection and reasoning start to help.

Why “Just Remember, it’s Not About You!” Doesn’t Always Work

We’ve all heard comforting advice like: “Don’t take it personally — their reaction has nothing to do with you.”

It’s well-intentioned, but here’s the problem: it speaks to the thinking brain (the neocortex), not to the part of the brain where emotional memory lives (the limbic system, particularly the amygdala).

That emotional memory system stores experiences somatically — through feelings, sensations, and implicit associations. So even if you understand something rationally, another part of your brain might still be running an old survival pattern that says:

“When someone withdraws, I’m in danger.” “When someone’s angry, I’m to blame.”

That’s why you can know, logically, that a friend’s mood or your partner’s defensiveness isn’t about you — and yet still feel like it is. The body remembers. And until that implicit memory has been safely processed, the rational insight alone can’t rewrite the reaction.

The Integration: Why We Need Both

Neither approach is “better” — they serve different functions at different stages.

• Bottom-up helps us regulate so that the system feels safe.

• Top-down helps us integrate so that the mind can make meaning and choose new patterns.

You might think of it like this:

The body calms the storm. The mind makes sense of the weather.

In practice, this could look like:

1. Notice a trigger or emotional surge.

2. Pause and regulate — breathe slowly, feel your feet on the ground, shake out any excess energy or look around the room, naming objects as you see them.

3. Once calmer, reflect — what story was I telling myself? What might this part of me need to feel safe or seen?

The order matters. Trying to reason your way through a storm before calming the body is like trying to navigate while your compass is still spinning. And for those of you who are parents, that’s why trying to reason with a tantruming or upset child is pointless — and can sometimes make them worse. It’s about helping them regulate before trying to reason with them — and it’s the same for ourselves.

A Takeaway for Everyday Life

Next time you find yourself saying, “I know better, so why can’t I feel better?”, try this sequence:

1. Body first: what sensations are here? Tight chest, racing heart, heaviness?

2. Regulate: slow your exhale, press your feet into the floor, shake it off or look around the room.

3. Then think: once your body softens, revisit the thought — what new perspective is available now?

   
   

Over time, this builds a bridge between your body’s instinctive responses and your mind’s ability to understand them. That bridge is where real transformation happens.

Over to You

Have you noticed times when your body reacts before your mind catches up — or when your logical understanding just doesn’t seem to help?

I’d love to hear your experience.