Music Therapy and Counselling as a Whole-Person Approach
- Elaine, MMT, CCC, MTA
- Jul 8
- 5 min read
It’s common to ask, “How will therapy actually help me?”
One helpful way to understand this is by looking at how the brain processes experience, and how we can support healing and growth from different angles.
You may often hear the terms, “top-down” and “bottom-up” approaches. Some therapeutic approaches start with your thoughts, awareness, and intentions, which help you gain insight and shift patterns through reflection and language. Others begin with the body and nervous system, which works with your physical sensations, emotional triggers, and unconscious responses that happen before thinking even kicks in.
Both are important, and both are connected. The brain and body work together constantly, so it makes sense that effective therapy supports the whole person, not just the mind or the body in isolation.
In the post below, we’ll explore what top-down and bottom-up approaches mean, and how music therapy and counselling integrate both, creating space for change that feels grounded, safe, and sustainable.
Top-Down Approach: The top-down approach starts with general ideas or theories about how the mind works. From these big ideas, we try to understand and explain specific symptoms or behaviors. Instead of looking at the details first, this approach uses what we already know to guide how we study and diagnose mental health challenges (Achenbach, 2020).
Some top-down processes include:
Focus and attention – Choosing what to pay attention to and ignoring distractions
Problem-solving – Using logic and past knowledge to find answers
Planning ahead – Thinking about the future and making steps to reach a goal
Self-control – Stopping yourself from acting on impulse
Making decisions – Weighing choices before picking the best one
Reading social cues – Understanding other people’s feelings and actions
Using memory – Bringing up past experiences to guide what you do now
Setting goals – Knowing what you want and how to get there
Changing behavior – Adjusting actions when something isn’t working
Seeing the big picture – Looking beyond the moment to understand what’s really going on
Bottom-Up Approach: The bottom-up approach starts with what you observe (like a person’s actions, symptoms, or test results) and using that information to understand what might be going on. It builds understanding from the ground up, using real data instead of beginning with a theory or diagnosis (Achenbach, 2020).
Some bottom-up processes include:
Sensing danger – Quickly noticing when something feels unsafe
Reacting fast – Responding to things immediately without needing to think first
Feeling emotions – Recognizing how your body feels when you're scared, excited, or calm
Being aware of your body – Noticing tension, pain, or comfort in your body
Calming down – Using breathing or movement to lower stress in the body
Reading your own signals – Telling when you're hungry, tired, or nervous
Building safety – Learning what helps you feel safe in your environment
Trusting your instincts – Listening to your gut when making quick decisions
Tuning in to others – Sensing other people’s moods through tone, movement, or expression
Regulating energy – Knowing when to rest or get moving based on how your body feels
To summarize…
Aspect | Top-Down | Bottom-Up |
Direction | Cortex → Body | Body → Cortex |
Focus | Thoughts, expectations | Sensory input, emotional arousal |
Brain Area | Prefrontal cortex | Limbic system, brainstem |
Psychopathology | Unhelpful thoughts → symptoms | Body reactions → symptoms |
Examples | CBT, DSM diagnoses | Somatic therapies, neurodevelopmental |
Top-down approaches in therapy focuses on cognitive processing, verbal communication/interaction, awareness, and changing thought patterns. This might include traditional talk-based modalities such as, Cognitive Behavioural Therapy (CBT) and Dialectical Behavioural Therapy (DBT). Bottom-up approaches focus on bodily sensations, subconscious processes, and nervous system responses. This might include Eye Movement Desensitization and Reprocessing (EMDR) and Somatic Experiencing.
As our bodies are made up of systems that are interconnected, it is only appropriate to treat the body the same way in therapy - by utilizing approaches that are both top-down and bottom-up. How does music therapy and counselling work in a bottom-up and top-down approach? Music activates multiple body systems all at once, making top-down processes and bottom-up processes happen simultaneously.
Bruscia (1998) identified four primary methods of music therapy. The simultaneous bottom-up and top-down processes are summarized under each method.
Receptive methods include:
Listening to music live or recorded
Music and mindfulness, guided music and imagery
Relaxing or energizing playlists
Listening to music and journaling or reflecting
Bottom-Up | Top-Down |
Entrainment and grounding | Focus and attention |
Physiological/emotional responses | Making meaning from song lyrics |
Promoting stimulation or relaxation | Facilitating memory or reminiscence |
Recognizing sense of like/dislike | Engaging in personal reflection |
Calming the nervous system | Connecting music to past experiences |
Re-creative methods include:
Singing familiar songs on your own, with another person or in a group setting
Playing instruments to re-create music in a similar or different way (e.g. song covers)
Bottom-Up | Top-Down |
Entrainment and rhythmic regulation | Attending to timing, pitch and dynamics |
Movement necessary to create music | Processing song lyrics and meanings |
Regulating energy through tempo | Using memory/recognizing melodies |
Emotional activation in familiar songs | Following structure and sequence |
Strengthening motor skills | Engaging cognitive flexibility/adaptation |
Improvisational methods include:
Spontaneously creating music, with sound, voice, instruments, and/or lyrics, on your own or with the therapist
The therapist listens, interprets, and musically responds to the client’s playing
Free drumming or sound exploration
Bottom-Up | Top-Down |
Expressing emotions non-verbally | Focused and sustained attention |
Emotional regulation via rhythm/tone | Sequencing notes/rhythms |
Accessing unconscious material | Choosing instruments/creating structure |
Engaging in sensory-motor pathways | Making in-the-moment decisions |
Mirroring/co-regulation with therapist | Using symbolic thinking and metaphor |
Compositional methods include:
Writing a song about a personal experience with therapist’s support
Recording a song or performing after as part of therapeutic process and closure
Collaborative songwriting with the therapist
Bottom-Up | Top-Down |
Emotional expression via lyric writing | Planning lyrics or melody |
Non-verbal processing with music | Sequencing musical ideas/themes |
Engaging the senses in sound | Solving creative problems |
Building self-regulation in performance | Performing or recording music |
Shifting rhythm and melody to manage energy | Integrating reflected emotional content |
That’s the beauty of it
In a single moment, whether you're writing a song, drumming with a therapist, or just listening deeply to a new or familiar song, your nervous system might be calming down (bottom-up) while your mind makes sense of a painful memory or sets a new intention (top-down). It's one of the few tools that can engage your thoughts, emotions, memories, and physical responses all at once. There’s no need to separate the cognitive from the emotional or the physical (though it helps us understand what is happening). Music lets them work together in harmony and we help facilitate that process.
This overlap is what makes music therapy and counselling so powerful. we don’t just help you talk about your experiences, we help you feel them, process them, and move through them, all in a way that feels safe, creative, and deeply human. It’s a whole-person approach, where it’s not just about fixing symptoms, it’s about finding yourself again.
References
Achenbach, T. M. (2020). Bottom-up and top-down paradigms for psychopathology: A half-century odyssey. Annual Review of Clinical Psychology, 16(1), 1–24. https://doi.org/10.1146/annurev-clinpsy-071119-115831
Bruscia, K. E. (1998). Defining Music Therapy (2nd ed.). Barcelona Publishers.
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