Why Therapy Can Feel Worse Before It Feels Better
Six weeks into therapy, she left her session and cried in the car for twenty minutes. In the beginning, therapy had felt like relief. Finally, someone was listening. But lately, it felt harder. She was remembering things she had not thought about in years, noticing patterns in her relationships she could no longer unsee, and arguing with her mother in a way she never had before. She texted a friend: "I think therapy is making me worse." Then she wondered whether she should quit.
Many people start therapy hoping to feel better quickly. Sometimes they do. But it is also common for therapy to feel harder for a while before it starts to feel easier. That can be confusing and discouraging, and it leads some people to stop just when important change is beginning. This post explores why therapy can feel worse before it feels better, how to tell the difference between productive discomfort and a sign that something is not working, and how to talk with your therapist about it.
Change is rarely a straight line
It is natural to imagine progress as a steady upward climb. In reality, psychological change often looks more like a winding path, with plateaus, sudden leaps, and occasional setbacks.
Researchers studying the process of change in therapy have described patterns that are not gradual or linear, including periods of "disturbance and transient periods of apparent worsening" that can come before improvement (Hayes et al., 2007). Other studies have found that some people experience "sudden gains," large improvements between one session and the next, rather than slow, steady change (Tang & DeRubeis, 1999). In other words, a hard stretch does not necessarily mean therapy is failing. It can be part of how change unfolds.
Why therapy can feel harder for a while
You are no longer avoiding. Many of us cope with pain by keeping busy, numbing, or not thinking about it. Therapy often invites you to slow down and look at what you have been avoiding. That can bring up feelings that have been held at a distance for a long time.
Awareness can be uncomfortable. Once you begin to notice patterns, such as people-pleasing, self-criticism, or how you respond in conflict, it can be hard to un-notice them. That awareness is an important step, but it can initially feel like everything is going wrong.
Some therapies involve facing fears. Approaches used for anxiety, trauma, and obsessive-compulsive difficulties often involve gradually approaching what feels frightening. Done carefully and at a manageable pace, this can be very effective, but it is often uncomfortable in the moment.
Relationships may shift. As you begin to set boundaries, express needs, or change old roles, people around you may push back. Those changes can create tension before they lead to healthier relationships.
Grief may surface. Therapy can bring you face to face with losses: of relationships, of a childhood you did not get, of a version of life you hoped for. Grieving those losses can be painful, even when it is healing.
Vulnerability can leave you raw. Sharing deeply personal experiences can leave you feeling exposed or emotionally tired afterward. Some people describe a kind of "vulnerability hangover" following a meaningful session.
Productive discomfort, or a sign something is not right?
Not all difficulty in therapy is a good sign. It is important to tell the difference.
Discomfort may be part of the process if you generally feel safe and respected with your therapist, the hard feelings make sense in light of what you are working on, you have some sense of direction or purpose, and you are still able to manage daily life, even if it feels harder at times.
It may be worth raising concerns, or reconsidering the fit, if you often feel judged, dismissed, or misunderstood, you feel pushed to go faster or deeper than you are ready for, you leave sessions consistently overwhelmed without support to settle, or your daily functioning is declining significantly.
Talking with your therapist about it
One of the most helpful things you can do is tell your therapist how you are feeling about therapy itself. It might feel awkward, but a good therapist will welcome it. You might say:
"I've been feeling worse lately, and I'm not sure if that's normal."
"That last session stayed with me for days. Can we talk about it?"
"I think we might be going too fast for me."
"I'm not sure this approach is working for me."
Research shows that the relationship between client and therapist matters a great deal for outcomes (Flückiger et al., 2018), and many therapists see open conversations about tension or misunderstanding as an important way to strengthen that relationship. Raising concerns is not a betrayal of the therapy. It is often part of what makes it work.
Why people stop, and why it matters
On average, about one in five adults ends therapy before completing it (Swift & Greenberg, 2012). People stop for many reasons, including cost, logistics, a poor fit, or feeling better. Sometimes, though, people stop during a difficult stretch, just as meaningful work is beginning. If you are thinking about stopping, it can help to talk it through with your therapist first, even if you ultimately decide to end or take a break.
Taking care of yourself through the hard parts
Plan gentle time after sessions, such as a walk, a quiet meal, or time to rest.
Use the coping strategies you have been learning between sessions.
Lean on supportive people in your life.
Notice small signs of progress, which can be easy to miss during hard periods.
Remember that you can set the pace. It is okay to ask to slow down.
When to reach out right away
If you are feeling much worse, unable to function, or having thoughts of suicide or self-harm, please tell your therapist as soon as possible, or contact a crisis line. Feeling worse in this way is not something to wait out alone.
Reflection questions worth exploring
These prompts are best explored with your therapist or a trusted person.
What feels harder right now, and what might it be connected to?
Do I feel safe and respected with my therapist?
What have I noticed about myself since starting therapy, even if it is uncomfortable?
What would I want my therapist to know about how therapy is feeling for me?
What small signs of change can I see, even if things feel hard?
Support at Vive Wellness Therapy
At Vive Wellness Therapy, we know that the path through therapy is not always smooth. We welcome honest conversations about how therapy is feeling for you, including when it feels hard, and we work with you to find a pace and approach that feels manageable. If you would like support, we would be glad to hear from you whenever you feel ready.
References
Flückiger, C., Del Re, A. C., Wampold, B. E., & Horvath, A. O. (2018). The alliance in adult psychotherapy: A meta-analytic synthesis. Psychotherapy, 55(4), 316–340. https://doi.org/10.1037/pst0000172
Hayes, A. M., Laurenceau, J.-P., Feldman, G., Strauss, J. L., & Cardaciotto, L. (2007). Change is not always linear: The study of nonlinear and discontinuous patterns of change in psychotherapy. Clinical Psychology Review, 27(6), 715–723. https://doi.org/10.1016/j.cpr.2007.01.008
Swift, J. K., & Greenberg, R. P. (2012). Premature discontinuation in adult psychotherapy: A meta-analysis. Journal of Consulting and Clinical Psychology, 80(4), 547–559. https://doi.org/10.1037/a0028226
Tang, T. Z., & DeRubeis, R. J. (1999). Sudden gains and critical sessions in cognitive-behavioral therapy for depression. Journal of Consulting and Clinical Psychology, 67(6), 894–904. https://doi.org/10.1037/0022-006X.67.6.894
This article is provided by Vive Wellness Therapy for general informational and educational purposes only. It is intended to be used alongside professional therapy and is not a substitute for assessment, diagnosis, or treatment by a qualified health professional. Research and clinical guidance evolve over time, and information in this article may become outdated or contain inaccuracies. If you are in crisis or thinking about suicide, call or text 9-8-8 (Suicide Crisis Helpline, available 24/7 across Canada; in Quebec, calls connect to 1-866-APPELLE). If you or someone else is in immediate danger, call 9-1-1 or go to your nearest emergency department.
