person at dusk for blog entry. feeling worse after therapy session

What to do if you are Feeling Worse after your Therapy Session

Feeling Worse?

 

So you have been going to your therapist for a few sessions now and you have felt good after your appointments.  Suddenly, however, you get home from your most recent appointment and you are feeling worse.  You notice you are having an increase of anxiety or depression or just overall discomfort.

“Is therapy making me worse?” You ask yourself

This is completely normal to happen at some point and various points along the therapy journey.  Change is uncomfortable.  Chances are it is a GOOD thing that you are experiencing a slight increase of symptoms.  It means you are moving outside of your comfort zone and the work is happening.

How to cope

  1. Keep a log of what is going on.  Don’t analyze and overthink the situation (I know easier said than done).  Just keep a note of how you are feeling and when you have the feelings.  Make note of what is more difficult for you to do.
  2. Engage in self care.  I’m sure your therapist and you have worked on self-care and calming techniques. Use those.  Guided imagery, mindfulness, progressive muscle relaxation.  Or engage in a hobby or activity – go for a walk, take a bath, read a book (whatever works for you).
  3. Know that it will pass.  If this is just a response to discomfort and working in therapy know that the “worse” feeling will pass and know that it means you are changing and doing what you set out to do in therapy.
  4. Allow yourself to feel.  It is important to be mindful of the feelings and not completely run away from them.  They are informative to you and your therapist.  Allow yourself to sit with the discomfort for a while before jumping into your self care.  This will help you increase your tolerance for emotions.

Call your therapist if:

  1. The symptoms persist or continue to worsen more than 2 or 3 days.  You know yourself and your baseline and if you are not falling back into your usual swing of things it would be good to inform your therapist to see what he/she recommends that you do.
  2. If the above coping is not “working.”  If you are feeling your feelings, logging them, engaging in self care and using positive statements of “it will pass” and the symptoms are significant enough, then please call!
  3. If you call into work because your symptoms are that significant to warrant inability to function.  Mental Health Days are good here and there.  But if you are calling in because you feel you cannot perform your job  because your depression is keeping you in bed or your anxiety is through the roof. Call your therapist immediately.

What is my therapist going to do?

Your therapist will assess the situation by asking you about your symptoms and functioning and determine the best level of intervention.  It may be reviewing coping strategies, asking you to call on your supports or scheduling you to be seen again within the same week to work on re-stabilization.

Your therapist is trying to help you facilitate change.  So sometimes we push you into your discomfort to illicit a response.  With the nature of therapy and mental health something can be triggered that you and your therapist are both unaware of that result in pushing too much and the symptoms increase more than we wanted them to.  These things happen and your therapist is trained to help you re-stabilize and put together a plan of action as you continue to move forward in therapy.

DON’T DROP OUT OF THERAPY

Whatever you do PLEASE CALL YOUR THERAPIST.  I know you went to therapy to feel better and not worse, but again, it is part of the process.  If you drop out of therapy you are leaving with an open wound that could become infected.  If you choose that now is not the right time for you the be in therapy, at least meet with your therapist 1 or 2 more times to help you stabilize before ending.
If you have questions regarding this topic/blog entry I encourage you to comment below or send me a message.

Share this:



28 Comments

  1. John Harrison

    Great post! I especially like #4. Sitting with your discomfort. All the getting away from what you’re feeling creates alot of stress and tension. “This will pass”. I’ll be sharing with my clients!

  2. Lisa

    Yes. Sounds good in theory. But I actually hate that therapist now…

    • Stacey Steinmiller

      Stacey Steinmiller

      Lisa,

      I’m so sorry to hear about this situation. Most of the time these situations can be worked through but maybe you had a therapist that had poor clinical judgement and I am sorry you experienced this. Unfortunately I have heard stories like this in my office many times of people’s past experiences in therapy. I hope you have connected with someone who you can trust to help you through the difficult times.

      -Stacey

  3. Andrea

    What if you want to talk about something, but it is way too painful, and your therapist feels like you should talk about something else instead that is more positive. I really want to talk about stuff, but I don’t know how to open the gateway or how to say it.

    • Stacey Steinmiller

      Stacey Steinmiller

      Hi Andrea,

      I’m sorry to hear you have some really painful things deep inside. It sounds like you are ready to tell your story but your therapist is worried about your symptoms becoming worse and how that will affect your day-to-day life? I would let you therapist know that you want to tell your story and he/she should be able to help you develop the coping skills necessary so that you can go to that painful spot without compromising your day to day functioning (being able to work, care for family, etc). A lot of self-care is needed and ability to feel those emotions rather than shutting down from them. If you’re newer to therapy it takes some time to open your “window of tolerance.” If you feel you have the skills necessary I would tell you therapist and open a discussion about your desire to go there but you need the support and guidance, and that’s why you have a therapist! Invite the conversation in therapy and I’m sure your therapist would be more than receptive to talk about your desire to tell your story and putting a plan together on how to make that happen as a part of your goals for treatment.

      Good luck!

  4. John applewood

    Or you’re just a terrible therapist it’s easy to know what’s wrong with yourself and if you feel worse after therapy it’s not some breakthrough your therapist is just awful

    • Stacey Steinmiller

      Stacey Steinmiller

      John,

      I’m sad to hear this. There are some not good therapists out there and this article wasn’t written to excuse them. The article is intended for clients who may be doing deep trauma work that opens ups wounds and the work can be up and down sometimes. As indicated sometimes the downs, especially after a reprocessing session, should only last a short period of time while the brain continues to do some of the work on its own. If it is ongoing then something important is being missed by the therapist if the client continues to feel worse. I apologize if there is any miscommunication on what this is referring to.

      Well Wishes,

      Stacey Steinmiller, LCSW

  5. Nathan

    This happened to me when seeing a psychiatrist that i thought i was seeing just for meds, but turns out there was psychodynamic therapy also happening.

    When i started to feel much worse and called to quit, i got tricked into another session. This was not intended to stabilize, but to go all out to keep me in treatment. I felt blamed for “not being open enough,” “overintellectualizing,” and “not believing” enough in treatment. I left feeling even worse and actually became suicidal (never experienced anything like it before treatment).

    After a series of emails where our disconnect about what was happened in therapy became apparent and (through review of my medical record) an attempt by the therapist to bring me back to treatment, i did return to try and reengage.

    However, after attempts at better contracting my limits for my own safety and “being more open” about what i was experiencing in the therapy relationship, the therapist pushed to end treatment. In reviewing my record, he also included more diagnoses during this time that he never shared with me.

    So after being admonished for not bring open enough, i was pushed away when being more open.

    Before this experience, i was a graduate student with a great scholarship, previously worked at the management level in community health organizations, and had a full social life. Almost six years later, i didnt finish my program and it is too late to go back, i am unemployed, live with family, and am almost completely isolated.

    I have never been able to trust other therapists and have found continued mental healthcare a waste.

    Please inform clients BEFORE therapt begins that things can get much worse and how you wouls handle it if it did. Clients have to live with the outcome of thetapy (positive or negative) so they need this info upfront to make more informed decisions.

    • Stacey Steinmiller

      Stacey Steinmiller

      Nathan,

      Thank you for sharing your story. It sounds like maybe try were seen at a clinic, I am unsure. Unfortunately there are some bad practices out there. I used to work at a clinic and had seen unhealthy practices which caused me to leave and start my own practice. I hope that you can find healing in some form that you may be able to connect to. It sounds like you are a very intelligent person with a lot to offer this world and this experience has impacted you in a very negative way. During the first session in treatment we go over informed consent and explore what therapy is about, what it will look like and important things to be aware of. I am deeply saddened by your experience. I wish the best for you Nathan.

      Stacey Steinmiller, LCSW

      • Nathan

        Nope – this was a highly recommended almost concierge style private practice psychiatrist. And he is by all means a reputable, effective professional.

        To me, getting worse in therapy is just a possibility in the nature of the experience. If you believe it can be a potent and heloful treatment, it can also be potentlly hurtful.

        In my case, consent and expectations were bigger issues. I was uninterested in, unprepared for, and not in position to benefit from (could not commit to an oprn-ended, indefinite process) the kind of therapy iwas engaged in. I just wanted some kind conversation and to try some medications ehen i was feeling low.

        Unfortunately, as you say, once therapy starts and things get worse, “wounds” can get “infected.” For ne though, NOT seeing a therapist after things started getting worse would have neen better. It was my trwatment and i should get to decide when its over. Or better yet, i never should have went in the first place.

        • Stacey Steinmiller

          Stacey Steinmiller

          Ugh. I’m sorry to hear this Nathan! You make some very good points. If you’re gonna do deep work then it needs to be discussed and the therapist needs to be skilled in making sure to keep the client “stable” for lack of better words so that if things come up they can be managed properly. Sounds like the psychiatrist was not skilled in a trauma-informed treatment modality which helps to avoid these problems. Like you said, you thought you were just getting medications, but ended up being much more than that. Bottom line is you’re right, you should be the decider of your treatment!

        • steve

          Wow, Nathan…I have struggled for many years to understand what happened in my own therapy, and this I feel is sort of the crux of it. Now that I’ve stopped crying, I can say I also personally wish I had never done psychodynamic therapy which I now refer now as “emotional cutting” therapy. The folks who practice this type of therapy literally worship emotional pain and believe that feeling it/sitting with it is equivalent to “wellness,” so it’s no wonder they continue to push this treatment. It can be very harmful imo, and I hope more people like yourself continue to share their story with how it harmed them. Before I had psychodynamic therapy, I had a large group of friends and long-term relationships. Now, I also live at home with my parents with symptoms that are worse than the ones I went into therapy to treat. Frankly, I opened pandora’s box by going to therapy in the first place believing what I was told…that insight would cure me…so it’s my own fault, but if I had any idea this could be the outcome, I probably wouldn’t have made the same choice. I do still wonder how much better my life could have been without therapy in it.

  6. Venus Joseph

    I just had my first session with a therapist yesterday and when I was getting ready for bed I felt sad and even a little angry. I feel like the therapist didn’t believe me and felt that I was withholding information which I wasn’t. He would push me on certain topics and wouldn’t move on until I answered them. I don’t know if that is normal but it made me feel uncomfortable. I’m not sure what he expects from me or our sessions. I have trouble expressing myself in words and describing what I’m feeling I think he mistook that as I’m holding back or I’m embarrassed about how I feel. I told him at the end that I do want to meet again. Should I bring up these concerns next time? Am I overreacting, being to sensitive? should I wait for him to ask?

    • Stacey Steinmiller

      Stacey Steinmiller

      You are definitely not overreacting or being too sensitive! I’m glad you’re exploring this. I’d recommend sharing with him how you feel and guiding him a little bit about what you need. I understand bringing this stuff up can feel uncomfortable and confronting, but therapists are trained to not take it personally! I would let him know that you have trouble expressing yourself in words and need some time to process and explore and you aren’t holding back, it’s just new and unfamiliar. He needs to go at your pace. By bringing this stuff up it can really enhance the therapy and help you work through whatever it is you’re going through. If you still feel misunderstood then maybe it isn’t a good personality fit and you guys can explore that as well and he could recommend someone else. But let him know what’s going on, honor your feelings and don’t settle for less. Success in therapy is most dependent on a strong and connecting relationship with your therapist, so really it’s the most important thing so I wouldn’t let this one slide! Good Luck!!

  7. Diana

    Thank you for sharing. Very helpful.

  8. Steve

    No need to apologize, Stacey. Like, as a therapist, if you folks are aware you can make people worse with what you are doing, imo it’s on you to be doing these check ins with your clients, not the other way around. Therapists prefer, it seems, not to be proactive in this regard and just wait until stuff hits the fan. Better, I think, would not be apologizing to me (which doesn’t really do anything productive) but for you to say something like “instead of putting it on clients and saying call me if I’m making you worse, here’s the symptom evaluation form I use every week with clients to prevent this kind of thing from happening in the first place.”

    • Stacey Steinmiller

      Stacey Steinmiller

      Steve, I agree. Checking in is a vital process in therapy. There are form that exist that you’re speaking of, developed by Scott Miller that I’ve used in therapy. Thanks for bringing that idea to the discussion it is a highly effective tool!

  9. Kim

    Thanks for this article. I’m brand new to therapy and just saw my therapist for the 3 time last week. The first two sessions were easy, but this time he really pushed back and dug deep. Since, I’ve been experiencing heightened symptoms. This article is a good affirmation that this is part of the process. I didn’t really know what to expect from therapy.

    • Stacey Steinmiller

      Stacey Steinmiller

      Kim,

      I’m glad this article was helpful as you’re working through the therapy process. Good luck as you continue to dig deep and move through the tough spots. Best wishes!

  10. Teague

    Great article. Thank you. I’ve been seeing a therapist/psychiatrist for 5 months. I had a very deep, positive connection and transference (I got crushed out on her).

    She’s made some pretty big mistakes. We processed them but they still echo in my mind.

    For the past 5 weeks I have felt more incredibly depressed when after sessions. To the point where twice I haven’t been able to drive. I have no idea why except it feels like she isn’t getting something or is missing me in some way.

    I keep telling her during sessions that I feel like she’s missing me or that I’m leaving feeling really, really depressed. I also experience anxiety and dread the before going in to see her.

    I’ve been viewing my experience as a result of the work but I’m not so sure anymore. My life has actually gotten worse. I’ve started smoking marijuana at night in an attempt to regulate my emotions. I think she isn’t getting it and I think she isn’t able to provide a certain holding or containment that I need?

    It’s very confusing to me. How do I know if it’s the therapy work itself or whether I’m being retraumatized?

    And I wonder if my crush on her (I don’t feel it anymore but it might be lurking?) got in the way?

    I don’t want to leave this therapy and feel panicky at the thought. I don’t have other options at this point. But I’m worried and wondering that the therapy is damaging me.

    Thanks for any perspective you can shed. I have previous trauma from 2 therapists. I actually have PhD and used to work in mental health so one would think I would be able to figure this out but I’m lost and in terrible distress.

    Thank you-

    Teague

    • Stacey Steinmiller

      Stacey Steinmiller

      Teague, I’m sorry to hear this is happening. I’m glad you brought up your feelings to her. What I’m hearing is that you are not feeling understood by your therapist and if you have attachment trauma this would be a very big trigger. Not every therapist-client relationship works or jives, but you say this therapist for some reason is your only option? I would address with her again how you’re feeling and try to process how you can feel heard and understood by her (so you feel like she “gets” you like you’re saying). Tell her how you want her to respond and explore what you need… if it’s earlier issues coming up it might shed light onto more of the deeper issues and processes going on. Try to bring it up again, but if you guys can’t work it, maybe a different therapist could fit you better, maybe a male? or different persona. Those are my initial thoughts without knowing you. Best of luck and I’m so glad you are addressing this and working it though!

  11. Bette

    Many get help from therapy. You have to know mostly what you want and need in therapy. If you are not assertive and you don’t know what you need it will come out bad or you will just waste your time. If you are senitive like me, you risk gettting hurt badly. Three therapists asked me why I would go back to therapy after having a negative experience in therapy. It took 2 yrs. to fully get over it.. But I am still not who I was. I will never be the kind person I was and it bothers me so much. I felt shit on.

    • Stacey Steinmiller

      Stacey Steinmiller

      Bette,

      Thank you for sharing your experience. Feeling shit on is definitely not the experience you want from therapy. I hear you saying you’re sensitive; I also hear you saying you persevere. Best wishes to you in your healing journey.

  12. casey

    Hi. I have been seeing a therapist for three days, and I like him very much, and I find it nice to talk to, but I am sooo sad after these sessions. I have been going to therapy for years and I just don’t want to keep talking about the same traumas. I thought I was going to work on my medication, but he is not that kind of doctor. I also think there is transference, too, like the previous writer, so now I feel embarrassed and am clamming up about relationship issues. Sometimes I think maybe the same gender is a better fit? Especially since most of my issues are with the opposite sex. So frustrating…who would have thought this would happen. What is wrong with me?

    • Stacey Steinmiller

      Stacey Steinmiller

      Hi Casey,

      Sorry for such the late response to this comment. If often isn’t helpful to just rehash the same traumas but working on movement forward. There could be some transference issues which is best dealt with by bringing it up to your therapist. Have you had a same gender therapist in the past and it feel better? These often do matter for a number of my clients wanting a female therapist for whatever reason, and there are people that prefer male therapists too for their personal reasons. Either way I’d bring these issues up in therapy regarding feeling embarrassed and difficulty exploring these things in therapy and work on determining if these are things you can work on with your current therapist, or finding a different one is a better option. Good luck. I’m sorry you’ve been so sad, but I’d definitely bring these things up so that you can move through and not feeling like you’re just rehashing the same stuff over and over again.


Leave a reply