When therapy makes things worse

Can therapy really make things worse?  You’re probably thinking this would mean it’s time for a new therapist, am I right?  Sometimes this is true, and it would be irresponsible to assume otherwise.  However, we will cover that a bit further into the discussion.  We will first explore the inherent bias within the process of therapy that can set a person up for disappointment.  We will also discuss how the change process is ridden with discomfort, which can easily be interpreted as a “relapse” of symptoms. 

It’s common for people to arrive to therapy with an idea of what they want to change, work on, and explore.  There is also an expectation that the process is relatively linear: you gain some insight into your identified “problem” and your therapist helps provide a sense of relief or resolution of symptoms.  This assumption was really derived from the medical system and reflects how our culture treats physical illness.  We also live in a culture that equates wellness with freedom from pain or discomfort.  Evolutionary psychology points to that search for comfort and escape from distress as necessary for survival.  Our minds are organized to assess physical or emotional threats and seek out remedies that will keep us alive and in optimal health.  The backlash to this primitive response, within the modern world, has led to an increase of suffering in a big way.  We find ourselves in a terrifying opioid epidemic.  Large amounts of money are spent upon potentially unnecessary prescriptions, medical procedures, and other “solutions” that are advertised to be a quick fix in a consumer-focused and fear-driven society.  We are biologically wired to fear pain, which can lock us into an assumption our physical or emotional condition will worsen unless WE devise a plan to rid ourselves of the experience. 

Many therapists will open a dialogue about how these sociological factors can impede progress and even create a kind of disillusionment about therapy.  These conversations can normalizeunmet expectations and offer interesting paths to explore.  Fear, judgment, and uncertainty toward change are all factors that relate to therapy expectations. 

I use the metaphor of cleaning out a closet, attic, or basement:

All your previously tucked away boxes, that have collected dust and cobwebs over the years, are exactly where you placed them years ago.  There is a kind of comfort in this, even if you are in desperate need of some purging and reorganization.  Imagine these boxes lie secluded in a back corner or upon a high shelf.  Therapy involves taking out these boxes, dusting them off, and placing them into the light.  Therapy involves taking inventory, letting go of what is no longer needed, and re-organizing the things that are still serving you.  It’s normal to feel overwhelmed at what is in front of you!  Quite frankly, it can look like a mess once you really see what you’re working with.  It’s imperative you don’t stop here.  As you continue, clarity will start to emerge.  Through this process, new patterns are created. It’s okay to talk about the difficulties, take breaks, soothe your nervous system, and begin again.  This all happens within the context of therapy.  However, if you run out of the room when the cleaning has just begun, things will feel worse than if you continue to chip away at it all with your therapist as a guide. 

I often listen to my clients reflect upon how the anticipation of doing deeper work is much more daunting than the process itself.  Health, healing, and joy is always worth the discomfort. This becomes clear once you get a taste of what is possible on the other side of the pain. 

Let’s say you find yourself in a situation where you aren’t looking forward to your therapy sessions, you feel misunderstood, or your goals are not being met.  I encourage you to take responsibility to give your therapist feedback if something is not working for you.  This isn’t assumed to be easy, but the task in itself is often a very important part of the work.  It allows you to express how the relationship is not quite meeting your needs.  Assertive communication is such a necessary part of healthy relationship-building.  We don’t always get a safe opportunity to practice this skill; it isn’t always modeled productively in our culture or manyfamily systems.  When you take this emotional risk, it also allows both you and your therapist to examine possible misconceptions about the therapeutic process and identify ways your therapist can reasonably shift gears.  Although most therapists come to the table with a preferred modality or philosophical framework, this can often be modified to best suit your needs.  As much as it might seem like we are mind-readers, we really are not!  A good therapist will welcome your feedback, even if it might hurt their ego.  If a therapist ever becomes defensive and quick to dismiss your concerns, this might be an indicator of needing a new provider. 

Sometimes there is truly an inadequate client-therapist fit, which might be assessed intuitively if you don’t feel comfortable enough in the office to share.  Listen to your gut!  If you ever feel as though your therapist is not working to attune to your needs, listen openly to your concerns, or pushes therapeutic modalities you indicated do not resonate for you, it is time to find a new provider.  Be aware of your rights as a client, including the right to be respected as an individual, the right to be educated onto how your therapist adheres to healthy boundary-setting, the right to know how and why your confidentiality is protected, and the right to inquire about your therapist’s training in detail. 

In summary, therapy can make things uncomfortable, expose previously denied truths, and challenge you to entertain challenging feedback.  Symptoms may ebb and flow and new problems may even arise as old coping mechanisms are put to rest.  However, when dust gets kicked up as part of the journey, you should still feel as though you are driving forward in an active, respectful partnership.  The detours can be frustrating, but are handled with patience and ease when you feel a sense of trust within the therapeutic relationship.  Please post any questions below if you have concerns about the current trajectory of your therapy.