Friday September 11, 2026
Most people come to therapy because something has gone wrong. They are anxious, or depressed, or stuck in a pattern they cannot break. They expect the therapist to help them feel better. That expectation is reasonable, and in the long run it is usually met. But there is a phase of the work that almost nobody warns you about: the part where things get worse before they get better.
To understand why, it helps to think of a psychological problem as a wrestling match. Two forces are locked in conflict: one pushing toward growth, aliveness, or truth, and the other working to keep things as they are, because change is dangerous. Most of the time, the match is at a stalemate. Neither side is winning. The person muddles along, more or less functional, carrying a low-grade discomfort that never quite resolves but never quite becomes a crisis. This equilibrium can last for years.
Then something disrupts the balance. A relationship ends, a job becomes unbearable, a loss cuts deeper than expected. The stalemate breaks, and the person enters therapy looking for relief. What they may not realise is that the apparent calm they had before was not peace. It was two opponents locked together, immobile. The absence of visible struggle is not the same as resolution.
When therapy starts to work, things move. The side that was suppressed begins to gain ground. And paradoxically, that can feel terrible. Someone who has spent years numbing their ambition to survive a toxic workplace may start, through therapy, to feel the toxicity more acutely. Their creativity and drive are waking up, and the first thing those recovered capacities do is perceive the situation clearly. The person feels more agitated, more dissatisfied, more angry than when they started. From the outside, it looks like deterioration. From the inside, it is the beginning of change.
This is the point where many people quit. They came expecting to feel better. They feel worse. The reasonable conclusion is that therapy is not working, and so they leave. The tragedy is that they leave precisely when things are starting to move. They mistake the turbulence of progress for evidence of failure.
Part of the problem is expectation. Popular culture has a picture of therapy in which the therapist is a kind of cheerleader or spiritual guide, and every session ends with the client feeling lighter, more understood, more at peace. The reality is closer to a martial arts class. If you are sitting around chatting and leave in a pleasant mood, nothing happened. A productive session is one that works you. You leave feeling spent, maybe unsettled, sometimes shaken. The discomfort is not a side effect of the process. It is the process.
But I want to be honest about something. Not every time therapy makes you feel worse is a sign that the work is working. Sometimes it means the therapist got something wrong. They missed something important, or said the wrong thing at the wrong time, or misread what you needed. The difficulty, especially if you have not been in therapy before, is that these two situations can feel identical from the inside. Both involve distress. Both involve wanting to stop. How do you tell them apart?
You tell your therapist. When a client tells me they feel worse, my first response is not to reassure them. It is to ask: Can you put the feeling into words? That question is not a deflection. It is the work itself. Sometimes what emerges is that the client is feeling the weight of something they have been avoiding, and the increased pain is the pain of seeing clearly. That is progress. But sometimes what emerges is that I missed something, or said something that landed wrong, or inadvertently repeated a dynamic the client came to therapy to escape. When that happens, I say so. I do not pretend that the discomfort is always productive. A therapist who cannot admit to getting it wrong is a therapist you should be cautious about.
This is one reason I am sceptical of the idea that therapy can be reduced to techniques and protocols. A manual can tell you what to do when a client presents with a given symptom. It cannot tell you whether the distress in front of you right now is the distress of growth or the distress of harm. That judgment requires something no manual can supply: the ability to sit with another person in their discomfort, to resist the urge to fix it prematurely, and to be honest about your own contribution to it. If I have done something wrong, the worst thing I can do is insist that the client’s pain is a sign of progress. That is not therapy. That is gaslighting in a clinical frame.
So what would I want a prospective client to know? I would want them to know that therapy is an expedition, not a prescription. I do not know in advance what we will find. I am not a spiritual master who can see the destination from the outset. I am more like a guide, and we are exploring territory that is genuinely unknown to both of us. There are always surprises. Some of them are painful. Some of them are extraordinary. You cannot have the extraordinary without being willing to endure the painful, and you cannot know in advance which is coming next.
I would also want them to know what resolution actually feels like when it arrives. Remember the wrestling match. When both opponents are locked together, immobile, it can look like peace. But it is not peace. It is exhaustion. Real peace is what happens when the right side wins: when the part of you that was fighting to be heard finally gains the upper hand, and the part that was holding you in place lets go. That is a different experience entirely. It is not the absence of struggle. It is its conclusion. And it is worth every difficult session it took to get there.
Related: Choosing a Therapist · When Therapy Doesn’t Work · What Does Psychotherapy Actually Do?
If this way of thinking resonates, I invite you to get in touch.