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3 Ways Traditional Therapy Gets It Wrong – and Why a Whole-Brain Approach is Superior

By: Adrienne Loker, LCSW, SE, EMDR

Imagine a spectacular second story of a house – a large bedroom with a walk-in closet with clothes hung on hangers and organized by season and color. A spacious bathroom with a soaking tub, steam shower, and double vanity. In the middle of the room is a king-sized bed with fluffy pillows, positioned to take in the view of a 70” UHD Smart TV. On the wall are professionally taken family portraits with designer clothes.

But there’s a problem. You can’t effectively use any of these amenities, because the floor beneath it is being held together by termite infested popsicle sticks. There’s a gas leak from the stove in the kitchen, the thermostat is wonky, and the circuit breaker keeps getting tripped. To top it off, the smoke alarms are broken and won’t stop beeping. How can we begin to think of soaking in a tub when the weight of the water could crush the floorboards? Or watching our favorite show when the electricity keeps going out?

Problem #1: Our Brain Processes from the Bottom to the Top

This is the first problem with traditional talk therapy: We enter a home on the second story rather than the first. We expect to be able to utilize these sophisticated features, despite the barriers to engaging them fully.

Trauma Therapy Richmond VA

Let’s replace the well-organized walk-in closet with critical thinking and analysis. And instead of a spacious bathroom, we have compassion, empathy, and perspective taking. Our bedding and pillows are our sense of self and identity. Our incredible TV is our narrative memories, and the pictures on the wall are our hopes and dreams.

Just like how a second story can only be built after the first story is there to support it, these brain functions are the last to develop – beginning around age six and maturing in our mid-20’s. Whereas, our first floor begins construction at the moment of conception.

Let’s replace the gas leak in the kitchen with our ability to digest food – absorbing nutrition and expelling any waste. Not only does the thermostat regulate our internal body temperature, but it also dictates the flow of oxygen and blood to our organs and muscles – communicating the desired behavior of our appendages. Our circuit breaker helps us execute a fight, flight, or freeze response. And let’s not forget our popsicle stick framework – rather, our ability to elicit caregiving behaviors from others – and our smoke alarm, which are the memories of every time we succeeded at surviving.

When people come into therapy, there is usually a lot of activity happening on their first floor. However, there is no language function in this part of the brain to fully articulate what the issues are. Instead, it’s often disclosed in a cryptic way, such as complaining of poor sleep, mood swings, anxiety, panic attacks, or depression.

Picture it this way: A client comes into therapy complaining that every time they turn on the TV in their bedroom, the power in the whole house goes out. The well-meaning therapist advises them to unplug other appliances in order to preserve power. This proves to be helpful and improve the frequency and length of time their client can watch TV, but the problem still continues to happen. Without rebalancing the circuit breaker, the client will have to resort to managing this problem for the long term.

In talk therapy, this looks like learning stress management techniques, reframing a situation to look at it differently, or even challenging the veracity of one’s thoughts. Much like the suggestion to unplug other appliances, these are helpful tools. But they don’t address the issue at the root.

Problem #2: Trauma Is Not Upstairs Anyway

Not only do we have to enter a second story structure from the bottom to get to the top, but we also need to spend time on the first floor – where trauma lives.

Trauma is not a crooked family portrait on the bedroom wall, it’s the mis-calibrated smoke alarm. This smoke alarm went off one time, when the popcorn caught on fire in the microwave, and now any time there is activity in the kitchen, it goes off. Or, perhaps there were multiple popcorn fires in the microwave, but it never went off until the whole kitchen caught on fire, and it hasn’t stopped beeping since.

Trauma therapy isn’t about the fire – it’s the memory of how we responded, and how this influences our present-day responses. We can’t reprogram the smoke alarm by yelling at it from the upstairs bedroom.

Trauma treatment explores how our alarm systems and circuit breakers have become calibrated with hyper sensitivity (or de-sensitivity) to threat. When we bring a sense of safety to these major drivers in our nervous system, they can begin to settle so that we can begin to enjoy the things our upstairs has to offer.

Problem #3: We Can Cause More Harm by Overly Focusing on the Upstairs

Many trauma survivors and mental health seekers come to see us for therapy intensives after feeling as though they’ve previously failed at therapy. They’ve been limiting their appliance usage for so long, but still keep experiencing power outages. Or they’ve been screaming at the smoke alarm, but now in addition to the obnoxious beep, they’ve also lost their voice. They come in feel inherently broken, stuck, or as though something is wrong with them.

This type of shame spiral can be retraumatizing, especially for individuals who already experienced feeling these things about themselves from previous relationship trauma.

What Does a Whole-Brain Approach Look Like?

A whole-brain approach is both top-down and bottom-up – recognizing that the majority of the attention needs to take place in the bottom.

Once the smoke alarm is reset, we need to check the batteries in the alarms throughout the whole house. Once the circuit breaker is upgraded, we need to make sure everything is plugged in appropriately and that all the electrical sockets work. Once we shut off the gas leak in the kitchen, we still need to air the entire house out.

There are many bottom-up approaches to therapy, all of which can be integrated into a multi-bottom-up treatment plan. Our specialties include Eye Movement Desensitization and Reprocessing (EMDR), Somatic Experiencing, Somatic Movement Therapy, Internal Family Systems, Brainspotting, Psychodrama, Art Therapy, and polyvagal-informed approaches.

If you’ve plateaued in your current approach to healing and wellness, it may be time to try something new. Reach out to us today for a consultation: 804-203-2100 or

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