When starting psychotherapy makes you feel worse

Are you worried about starting psychotherapy? Are you anxious that it may make you feel worse before you get better? This can happen sometimes, and it can be disheartening when you've been hopeful that the therapist will help you with what you struggle with. Stopping therapy after just a few sessions can feel like the only thing to do to protect yourself and prevent the feelings you are desperate to get away from becoming overwhelming.

I want to explore how this can happen, the reasons clients find starting therapy makes them feel worse, and offer suggestions on what to do since the truth is that in the majority of cases, the best way to feel better is to keep going.

There are of course a myriad of reasons why you might feel worse after starting therapy; the most common is that it gets you in touch with what you really feel. If we have struggled with a difficult situation for a long time, we can find all sorts of ways to protect ourselves from our feelings, to block out, ignore, dampen down, freeze the pain and sadness, fear and loss. We need to do this to get through the day so that we are not overwhelmed. The problem is that the feelings, thoughts and memories we try to block out don’t disappear when we do this, and they continue to influence our mood and behaviour, even if we are not aware of them.

If you have ever found yourself suddenly angry with someone, crying at a film, or anxious over small issues and you don’t understand why these could be signs of deeper emotions beyond your awareness which nevertheless impact on you.

Starting talking to a therapist brings these underlying feelings to the surface: the process brings them to your attention, so you become more aware and begin to experience them directly, rather than vicariously through being angry or upset about external situations.

It’s as if your feelings have been frozen. Therapy melts the ice and the feelings come back to life, reawakening. This is the first step to recovery, but it can be a painful first step.

If you are coming to therapy because you are still in the grip of an earlier trauma, then it can be the traumatic memories which get reawakened. I have written in other articles about how traumatic memories can be buried deep within the non-verbal part of the brain and in the body because of the way the brain/body responds to and remembers the experience of a traumatic event. The Amygdala, where the memory is held, has no sense of time or place. When something happens which reminds that part of the brain of the original traumatic event, it thinks that it’s happening again, and sends out the same stress hormones to activate the body’s fight or flight mechanisms. The original event may have been an assault, sexual abuse, an accident, or bullying.

Talking about what happened, especially if you do this too quickly, can trigger this response from the Amygdala, bringing back images, feelings, physical sensations, pain, terror, and confusion. Scenes from the trauma can start to replay in your dreams.

It can feel safer to leave therapy, to block the memories, and feel numb. The problem is that avoidance, taking steps to avoid any reminder of the trauma, to not talk about it, and to avoid having to think about it, is a symptom of post-traumatic stress disorder (PTSD). This doesn’t mean you have PTSD just because you don’t want to think about traumatic experiences, but avoiding or ignoring the impact of a traumatic event won’t make it disappear. The trauma will find ways to burst out, no matter how much you try to ignore it. Another symptom of PTSD is hypervigilance; being constantly on edge, on alert, looking for the next threat. The brain’s threat detection system does this automatically, without us even realising it, and is so highly-tuned when in this state that seemingly innocent gestures, someone’s tone of voice, facial expressions or remarks, can remind it of the original trauma and release the same feelings and sensations as before.

It could also be something about the therapist. Being able to trust your therapist and feel safe enough with them to explore your inner world and the deep, painful feelings you have been struggling with is essential to the successful outcome of the therapy, and if you don’t feel safe or that you can trust the therapist, this can impact on your feelings about continuing with the therapy.

This will be obvious in the (thankfully very rare occurrence) that the therapist’s work is not up to professional standards, if they don’t take time to assess you properly to understand your story and needs, and go too far into the work too quickly before they have built trust and rapport with you. Sometimes, however, you may meet with an incredibly professional, skilled and empathic therapist but still find that you just don’t feel comfortable with them. Again, there could be multiple reasons for this, one of which might be what therapists refer to as 'transference'.

'Transference' was first used by Sigmund Freud in the very early days of psychoanalysis (the ancestor of psychotherapy) to describe a phenomenon he observed with his patients where they seemed to be relating to him in the same way they used to relate to a significant figure from their early life, such as their father. Patients, Freud thought, brought with them traces of early relationships when they entered psychoanalysis, and transferred them onto the analyst. In this way, the issues and conflicts the patient had experienced in the earlier relationship would play out in the current relationship with the analyst. The patient (in Freud’s terms - 'client' in contemporary language) would therefore, during sessions of analysis, get in touch with the same feelings as within the earlier relationship.

The phenomenon of transference still exists and happens all the time, even outside of therapy. You will have had the experience of meeting someone new and finding you are relating to them, experiencing them in the same way that you experience someone else you know, or even that the new person reminds you of someone else. These are examples of transference.

Where the experience of the earlier relationship was difficult or painful, and these feelings emerge in the therapy, this can be another reason to want to get away.

So what can you do?

The first step is always to ensure you engage a fully qualified psychotherapist or counsellor who is accredited by a nationally-recognised accrediting body such as the UKCP or BACP. Counselling Directory vets all the therapists who advertise on the site, so you can have confidence in their qualifications and experience. It can also help to talk to your therapist on the phone first, to get a feel for them and how they work before you meet.

If, after a few sessions, you do get the urge to leave, even though this can be incredibly strong, it can be helpful to talk to your therapist about them. Even if the feelings are part of a transference situation, and you are feeling negative about the actual therapist, you can feel a sense of relief by talking about it and thinking with your therapist about the origin of the feelings - which earlier relationship might be being reproduced in the therapy room?

If you find that you are overwhelmed by frightening memories, emotions and physical sensations from the past, it's again important to tell your therapist so that you can think together about how to pace the work so that you feel safe.

Safety is vitally important for recovery, especially if you are experiencing trauma. There can be no healing without safety, so ask your therapist how they can help you feel safe during and between sessions.

Eye movement desensitisation and peprocessing (EMDR) is a model designed originally for work with trauma, though it has since been applied to a wide range of other conditions. The model has procedures for building and maintaining safety from the start, making it accessible even if you’re feeling fragile. Any well-trained, professional and experienced therapist should be able to listen to you talk about your anxieties about the process and think with you about what you need to feel safe in the room.

If you are in this position, or have been, I hope you are able to talk to a therapist about your needs and how you can be kept safe. Psychotherapy can be a challenge, but if done correctly and you feel your anxieties have been held and contained, it can be a transformative experience which can leave you feeling much more at peace, and I hope you are able to find a way to benefit.