On Feeling Worse After Therapy
Pop culture depictions of therapy often present the idea that therapy is cathartic- that simply attending the session and expressing your thoughts and feelings to your therapist will lead to a release of emotions that will bring you closure, peace, and acceptance, improving your mood immediately.
But it is very common to leave therapy feeling mentally, physically, and emotionally exhausted, potentially experiencing negative emotions, stress, and/or an increase in other symptoms including urges to engage in dysfunctional coping behaviors. Sometimes that lasts for just a bit after therapy, or for the rest of that day, but sometimes it can linger throughout the week until the next session.
As unpleasant as that is, it is not necessarily a sign that therapy isn’t working. In fact- that exhaustion and increase in negative emotions and symptoms can even be a sign that the therapy is working.
1. The experience of engaging in therapy- dealing with uncomfortable and distressing emotions, thoughts, experiences, and behavior head-on, disclosing and processing those issues with your therapist, thinking deeply about issues and their cause, making big life decisions –is exhausting. It is hard work! And that work, although it is exhausting, is helpful. It’s like going to physical rehab after an injury- you have carefully but diligently work to build your strength back up. Doing that work is really tiring in the short run, but in the long run you will be stronger, experience less symptoms, and be able to handle emotional things without experiencing as much fatigue.
2. Although disclosing and processing something big (like trauma, but other things too) can be cathartic, it can also have the opposite effect. Particularly when a person has been suppressing or avoiding thoughts/emotions/experiences for a long time, finally releasing it can often feel both cathartic (relief from finally disclosing/expressing) but also painful. It can be difficult to put the emotions back afterword, and the experience of processing can lead to increase re-experiencing symptoms (like flashbacks).
3. Therapy can help people decrease emotional suppression and avoidance. This is great, because when we suppress emotions, we do it unilaterally- by trying to suppress negative emotions, we also suppress positive ones. So when the suppression/avoidance decreases, the amount of both positive and negative emotions is expected to increase. In this case, it’s actually a sign of doing better, although it may not feel that way immediately.
4. The work in and out of therapy often includes dismantling existing but dysfunctional coping mechanisms, and replacing them with new, functional coping mechanisms. That doesn’t all happen in one session- it takes time to identify helpful/functional new coping mechanisms, learn how to use them effectively, and make using them a part of your routine. That means that there are often periods where people are working on reducing use of dysfunctional coping mechanisms but don’t have a totally reliable and effective new coping strategy yet. For example, many people use some sort of avoidance as a dysfunctional coping mechanism. Reducing or ending use of avoidance means approaching emotions/thoughts/behaviors that the person previously felt incapable of approaching, and so starting to reduce avoidance will usually cause an increase in symptoms (like anxiety). After practicing approach strategies instead of avoidance for awhile, those symptoms will decrease and hopefully go away entirely. So again, it’s like physical rehab. In the short term, doing your rehab or your therapy is painful and exhausting and may feel worse than doing nothing at all. But in the long run, all of that work builds you up stronger and gives you new and better ways to manage distress.
Essentially, we expect that some of this will happen for most people. It’s an important although unpleasant part of the therapy process. Again, sort of like recovering from a medical illness or injury- the pain is part of the healing.
So, then, if sometimes good therapy can make you feel worse, how do you know whether your therapy is good-but-painful, or whether it’s just painful? A few things to consider:
1. Did your therapist explain any of this to you? Did they help you understand the potential short-term impacts of therapy, or help you prepare for how to manage short-term increases in symptoms?
2. Did your therapist do any kind of emotional containment at the end of sessions, to help you ‘put the emotions back’ before you leave? Or did they teach you how to do emotional containment on your own?
3. When you told your therapist about your increase in symptoms, were they validating and helpful? Did they respond in a way that helped you understand what was happening? Did they help you figure out what to do about it?
4. Does your increase in fatigue, negative emotions, or other symptoms seem to be tied to specific things happening in therapy? For example, are you more tired after a session of delving deeply into your emotions?
5. Do you find that you are experiencing a mixed bag of improved symptoms vs. worsening symptoms? For example (from the avoidance example above) are you decreasing your avoidance and finding that your anxiety is higher?
6. Do you have clear therapy goals? Are you and your therapist tackling those goals? Do you see yourself making some movement on one or more goals?
If most or all of your answers to the above are ‘yes,’ then probably you are experiencing good-but-painful therapy. If not, it’s worth discussing with your therapist and considering how to improve your experience- either with that therapist or another one.
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