Understanding bottom-up therapy: A path to integrating grief
When we think about healing from grief, we often imagine talking through our pain—finding words for what happened, making sense of loss, and rebuilding our lives through insight and understanding. While that’s certainly part of the process, grief also lives in the body. It shows up in tension, fatigue, restlessness, and the feeling that something deep within us has changed. Bottom-up therapy helps us meet grief at this deeper level—through the body first—so that healing can unfold in a more integrated and compassionate way.
What Is Bottom-Up Therapy?
Bottom-up therapy refers to therapeutic approaches that begin with the body’s experience rather than starting from thoughts or analysis. Instead of focusing primarily on why we feel the way we do, bottom-up approaches explore how we feel—what sensations, impulses, or movements arise when we touch into grief. These methods include somatic therapy, mindfulness-based practices, EMDR, sensorimotor psychotherapy, and other body-oriented approaches.
The term “bottom-up” contrasts with “top-down” therapy, which focuses on cognitive processes—such as reframing thoughts, analyzing patterns, or developing insight. In bottom-up work, the goal isn’t to fix or interpret grief, but to listen to it through the body’s wisdom.
Core Principles of Bottom-Up Healing
The Body Holds the Story – Our nervous systems record the experiences that overwhelm us. Grief isn’t just emotional—it’s physiological. The body remembers the absence, the shock, and the longing, even when words can’t capture it.
Safety Before Insight – Healing requires safety, not just understanding. Bottom-up therapy prioritizes calming the nervous system so that we can approach loss without becoming flooded or dissociated.
Connection Over Control – Rather than forcing ourselves to “move on,” we cultivate curiosity and gentleness toward what’s happening inside. Connection to self, to others, and to the sensations of the present moment become the foundation for resilience.
Integration, Not Elimination – The aim isn’t to make grief disappear, but to integrate it into the body’s story—so that the pain becomes something we can carry with more ease and less suffering.
Why Bottom-Up Therapy Works for Grief
Grief is not purely a cognitive experience—it changes our breathing, our posture, our sleep, and our sense of time. Traditional talk therapy can help us understand our emotions, but when the body remains tense or frozen, insight alone can feel limited. Bottom-up therapy helps bridge that gap by:
Regulating the nervous system: Techniques like grounding, breathwork, and mindful movement help restore balance when grief triggers overwhelm or shutdown.
Releasing stored emotion: Tears, trembling, sighs, or gentle movements can help complete the body’s natural stress cycles that were interrupted during moments of acute loss.
Building tolerance for presence: Over time, the body learns that it’s safe to feel again—safe to experience joy, sadness, love, and memory without collapsing under their weight.
Walking the Path of Embodied Grief
In a culture that often urges us to “get over it,” bottom-up therapy offers a different invitation: to come home to the body and let it guide the healing process. Grief, when met with presence and care, becomes a teacher—showing us where love still lives, even in the places that hurt the most.
By working from the body upward, we don’t bypass the mind; we simply give the body a voice in the conversation. Through this dialogue between sensation, emotion, and meaning, many find a more lasting and compassionate integration of their loss.
If you’re navigating grief and noticing how it lives in your body—through exhaustion, tension, or numbness—bottom-up therapy may offer a gentler, more embodied path forward. Healing doesn’t have to start with words. Sometimes, it begins with a breath, a tremor, or the courage to simply feel what’s here.
