Can Therapy Make You Worse?
What can you do if you think therapy is actually making you worse? Welcome to the So, How’s Therapy Podcast where we push beyond the traditional therapy format to demystify, debunk, and destigmatize therapy. Hosted by Karen Conlon, LCSW, CCATP.
Therapy doesn’t always feel good.
Sometimes it can feel really uncomfortable, difficult, or challenging. But you should never feel like therapy is retraumatizing, and you should certainly not feel like you are getting worse. In this episode, I’m covering all the ways that therapy might be making you worse, and how to address them.
What You’ll Learn
- What ‘Good Therapy’ should feel like
- How to know when things are turning for the worse
- How your Clinician’s skill set has to match your needs
- What to look out for
- That feeling bad in therapy doesn’t mean your therapy is bad
Hello and welcome to the So How’s Therapy Podcast, where we push beyond the traditional therapy format to demystify, debunk, and de-stigmatize therapy. I’m your host, Karen Conlon, and in today’s episode, I’m going to be addressing the question of can therapy make you worse?
As a therapist, this is a really important question that I think about, that I talk to colleagues about. It is a question that requires some thought, not only by us as the clinicians and people who care for your mental health, but also I think it’s a valid question for people to ask themselves as well as they go through the process of finding the right therapist, the right fit and making decisions as to whether to continue or pause or terminate therapy.
What is Good Therapy?
So why don’t we begin first by talking about what is good therapy? I want to say that the first thing to ask yourself in determining what is good therapy is to look inside yourself, think about how you’re feeling when you are in therapy.
That is just even good enough because you don’t even need to be in “Excellent therapy.” You can be in what we call good enough therapy, and feel that you’re in the right place, that you’re in a secure place, that you’re in an emotionally safe space.
The first thing is asking yourself, how do I feel in the therapy space with my therapist? Am I feeling emotionally safe?
Emotionally safe or emotional safety means that you feel confident and secure in being able to talk to your therapist about things that you’re thinking, that you’re feeling, that you may not normally feel so comfortable talking to other people about.
And when you feel emotionally safe, either with your therapist or with anyone else in your life, you feel like you can bring up the really hard stuff, the really difficult things, without having negative repercussions.
And by negative repercussions, I mean, you bringing up something that’s difficult and then feeling like you’re being rejected, or being judged, or that whatever you say may or may not be taken seriously and not really knowing where you stand. So that’s what I refer to when I say you should feel emotionally safe with your therapist.
Are You Looking Forward To Therapy?
The other thing that I would say to you is you’re looking forward to your next therapy session. Here’s the deal, you’re not always going to feel great. And that’s a big myth, that you’re supposed to feel good or that you’re always supposed to feel comfortable, or great, or feel better after your therapy session. That is not true. And I’m going to talk a little bit more about that myth later. But what I do want to say is that you should have some consistency in… Generally speaking, feeling better, feeling relieved, feeling perhaps that you have unloaded, been able to vent, and also maybe even been able to connect some dots and figure some things out.
And because you, generally speaking, feel this way in your therapy sessions, you are looking forward to seeing your therapist and going into therapy on a weekly basis. The other aspect of what I consider to be good therapy is consistency. If you have a therapist who is constantly rescheduling you…
And listen, we know that things happen. We all know that sometimes in our lives, we need to reschedule. This pandemic, and by the way, if you’re listening to this episode during the pandemic, or if you are somebody who’s listening to this episode past the COVID-19 pandemic, just to give context, that’s what I’m talking about. We are in the midst of this COVID-19 pandemic.
And so this pandemic has forced us to make changes in our lives, whether we wanted to make them or not. And so sometimes what we have learned to expect and to be consistent is no longer consistent.
And that might be a temporary thing, or that might be a more longer-term thing. But in terms of therapy, even when there are shifts or changes, generally speaking, you should be able to expect consistency. And I don’t mean just consistency in your therapist showing up. I mean, your own consistency in showing up.
Getting To Know Each Other
And also in terms of the relationship, you should feel that you are getting to know this person and that this person is getting to know you. So like I mentioned before, therapy does not have to be this amazing, excellent feel-good thing every single time. It can be good enough to be good therapy. What does it look like when things start turning south? And when therapy can actually make you worse? This is a tough one because everyone’s experience is very different and the things that they bring to the table.
We All Bring Different Things To The Table
And when I say they, I mean, patients, clients, therapists. What people bring to the table is very different. And everyone has a story. Everybody has an experience that shapes who they are and how they function in the world. The thing here though is that as therapists, we should be able to keep ourselves in check we should be able to be self-aware, and we should be able to seek out our own supervision externally and outside of the therapy space with you.
Your Therapy Should Not Be Your Therapist’s Therapy Time
In other words, your therapy time should not be your therapist’s therapy time. Because oftentimes we do bring into the therapy space behaviors that re-enact how you live in the world, and how you enact, and how you act and how you integrate with other people in your life. And sometimes those behaviors are really not working for you anymore.
And if you’re bringing those behaviors into the therapy space and your therapist is not someone who is aware, or self-aware, or doesn’t have maybe the experience to understand what’s happening, the same behaviors and the same reactions can be reenacted in the therapy space. And therefore, these not get addressed.
I’m going to talk a little bit more later about this particular dynamic. When I talked to you about something called transference and countertransference. But for now, I’m just going to mention that.
Another way that things really start turning south and when therapy is not helpful and actually can make it worse is when you are getting re-traumatized in the therapy space. How does this happen? Well, sometimes if you have a specific or certain traumatic experience that you’re being asked to talk about in detail, well, unless you really want to talk about it, are motivated to talk about it, even if you’re scared, but if you want to talk about it.
Unless it’s coming from you, if your therapist is kind of pushing the issue a little bit, and you’re finding that rather than feeling better after talking about it, you’re consistently feeling worse and feeling the symptoms of the trauma.
Even if they are visceral. Then that’s a really big red flag that therapy is making you worse. And again, I’m not saying that you shouldn’t talk about these things. What I’m saying is that it should come from you.
If you’re feeling like you’re being forced to talk about things that you don’t really want to talk about, or that you’re not ready to talk about, that’s a really big red flag and you should definitely listen to your instincts about what’s going on.
Do You Feel Like You Are Being Believed?
Another way where, or another instance rather, where therapy can make you worse is when you’re in the therapy space and you are feeling like you’re not being believed. For example, you may talk to your therapist about something that’s going on or something that’s gone on, and your therapist maybe has some kind of line of questioning where you’re feeling like you need to prove that your story is true and that your experience is valid.
And now you’re feeling very invalidated and like the person in front of you doesn’t believe you. And so instead of spending the time in your therapy space to process, and reflect and learn, you feel like you’re spending a lot of time trying to make sure that this person believes you. That in and of itself will absolutely make therapy, make you feel worse.
Growth Is Uncomfortable
It’s not an easy thing. It’s not an easy thing to necessarily see or understand or identify when therapy is making you worse, because here’s the truth of it. Growth is uncomfortable. You will hear me say that in this episode, you will hear me say that in other episodes. When you are growing, you are pushing through boundaries that you had set for yourself in the past. And that means that you’re also going to be dealing with things that you may not have allowed yourself to deal with before. You might be accessing feelings and emotions that you may not have ever allowed yourself to access.
Or maybe this is the first time that you were even identifying certain feelings. So all of that is uncomfortable. Growth is absolutely uncomfortable. And you need to learn to sit with that discomfort. So when you’re sitting with such discomfort, sometimes you’re also dealing with shame and guilt that come up because of whatever said experience it is that you’re talking about.
Let’s Debunk Therapy Always Making You Feel Great
I just want to take this moment to debunk the myth that you should be feeling great in therapy after every session or feeling better, because feeling bad in therapy does not mean that therapy itself is bad or that you’re getting worse. The issue lies in how often you are feeling worse after therapy. In other words, if you are feeling worse on a regular basis after therapy, that is a real red flag.
Another one of the things that I wanted to bring up that does come up often when you know that the therapy, or when therapy is not working, or when you’re getting worse, is that you are not seeing any increase in your own functioning outside of therapy. In other words, you leave your therapy session and on a weekly basis consistently you are finding that your mood is often worse after therapy on a regular basis.
Perhaps your ability to communicate your needs or express your feelings has actually worsened over time or stayed the same. These are clues that therapy may actually be making you worse. And in terms of communicating sometimes does happen where clients or patients don’t feel comfortable expressing something that doesn’t feel good to the therapist, because they don’t want to upset their therapist.
Your Therapist’s Emotional Wellbeing
I’m here to tell you today that it is not your job or your responsibility to take care of your therapist’s emotional wellbeing. I’m here to tell you that you can relieve yourself of that. You can liberate yourself of that because it is not your job. And if that is what you find that you’re doing. And in order to do that, you’re also lying to your therapist or omitting some things. This is absolutely something that can have therapy make you feel worse. You don’t have to be the ideal patient.
And if you feel that this is the only way that you can function in that therapy space with that therapist, it’s probably time to rethink whether this is a relationship that’s working for you or that you should continue. But before you do that, perhaps it is worth it for you to take a chance on your therapist and be open and honest about this.
And say to them, “Hey, this is what I’ve been feeling. And I’ve been feeling a little bit uncomfortable about this, but I haven’t wanted to say anything because I don’t want to upset you.” This could be a really good opportunity for some really excellent clinical work and progress to be made for you. So give them a chance. Another red flag about whether therapy can make you worse or not, or that therapy is making worse, is that you are constantly being told what to do by your therapist, rather than being guided or challenged or educated.
You Are Stronger And More Resilient Than You Think
All these things that are needed so that you can learn from within and take from your own resources, because you’re a lot stronger and a lot more resilient than you think. If instead of being challenged and guided and being helped to process and reflect, you’re being told what to do in every single situation. What that is doing is creating a dependence on that therapist and still a dependence on other people to tell you what to do, how to guide your life, or how to resolve problems.
It’s not really helping you learn how to resolve problems on your own and how to be your own resource, which is part of what we really want to do. The goal here is not to be in therapy forever, necessarily. What you want to do is use therapy as a space where you can learn about yourself.
Should Your Therapist Be Telling You What To Do?
When you can learn about family dynamics, interactions, how you became who you are today, what are the things from your past that have impacted the way that you function, and how you can make the changes today that are going to help you reach the goals and changes in your life that you want for the future. That is how you use therapy. But if somebody is telling you what to all the time, then chances are, you’re not going to learn much.
And you’re going to find yourself in therapy again, with many of the similar or same frustrations that you came with in the first place. I’d like to now move on to another area that I feel is really important in terms of looking at whether a therapy can make you worse or not. And that is the clinician’s skill sets. Before I go into that though, I want to say there are some people that let’s say call in and one of the questions or criteria that they have in determining who to work with is how long have you been practicing.
And while that is an incredibly valid question, I will caution anybody looking for a therapist to have that be a main factor in deciding who to work with. Because what research overwhelmingly shows is that the relationship, that therapeutic relationship, that alliance that is built between you and your therapist is actually the most important factor that contributes to positive outcomes in therapy. More even than clinical skill sets.
A Trusting Relationship With Your Therapist
And the reason for that, amongst other things, is that if you have a trusting relationship with your therapist, you will more than likely be open to bringing things up and discussing things that you may not have allowed yourself to discuss in an emotionally safe environment. And oftentimes there is nothing more healing than that. So I wanted to mention that first, because that is really, really, really important for you to know if you’re looking for a therapist and that is one of the questions that you have.
Their Skills Should Match Your Needs
That being said, there are some things that I recommend you look for. For example, your therapist skill sets should match your needs. If you’re looking particularly for specific things. For example, for people who are looking for, let’s say EMDR trained therapists. EMDR is a very specific therapeutic modality that focuses on helping people with trauma or traumatic experiences. That is a very specialized type of training and it requires very intensive training.
And so if you are looking at a profile and it says, the therapist profile says that they are trained in EMDR, I would want to ask about that and make sure that there’s been good enough or extensive training. Another specialized type of training is DBT, for example, dialectical behavioral therapy.
And these specifically trained therapists more often than not work with borderline personality disorder and other types of disorders where people struggle greatly with emotional dysregulation and suicidality and other things. Not just those things. But those are therapists who are also specially trained and do require very specific experience.
Cognitive Behavioral Therapy (CBT)
So it’s very important that your clinician matches your needs. In other areas where you do need training, but not as extensively as with those two examples is if you’re looking for someone who does cognitive behavioral therapy, CBT. So many people out there, a lot of clinicians state that they are trained in CBT, and they might have experience in CBT.
But if you’re looking for someone who really knows how to incorporate CBT, who understands its tenants and also can explain it to you in the right way. I think it’s appropriate for you to ask, are you CBT trained? And do you have experience? You can ask what type of experience. Because if you’re looking for someone who is CBT oriented, and what you have is maybe someone who is more psychodynamically oriented, not so much CBT, even if they have the training and the knowledge, if their orientation, or if their preference is psychodynamic work.
You may not get as much of the CBT work that you’re looking for. And that’s very important. Same thing if you’re looking for a therapist that is going to help you be more reflective and really look a little bit more within yourself and not so, let’s say strategy-oriented and focused on reframing and very specific tools. If that’s not your thing, then you probably don’t want to look for a CBT therapist. You want to work with someone who’s more psychodynamically oriented.
If Your Therapist Is Not Attuned To You And Your Emotions, What Can Happen?
That being said, that brings me to the next thing that can actually make therapy worse or that can make you worse in therapy. Is if your therapist is not very attuned to you and your emotions, as therapists, we have to really strive to have high emotional intelligence. Because when you have high emotional intelligence, you are able to be more attune or to be attuned to how people are feeling and kind of read the room, for lack of a better term.
And therapists need to be able to be attuned to your feelings and attuned to your body language. And even in this day and age of telehealth or teletherapy, that energy, that attunement still can come through.
Even if you’re not doing in-person therapy, you can still be attuned or not attuned to your client and vice versa. Not that the client needs to be attuned to your therapist, but it is important that your therapist is attuned. If you’re feeling like your therapist is kind of checked out or that you’re talking to someone who is there, but not really there, that can be very traumatizing.
That can be very hurtful. And that can really dig into areas that you’re already struggling with. Like, for example, if you’re struggling with low self-esteem or if you’re struggling with just being able to take up space, if that’s already an issue for you and you’re working with someone who seems to be kind of checked out or not attuned to your feelings, that can be very re-traumatizing and not helpful and make things worse.
Transference and Countertransference
Now, earlier I mentioned transference and countertransference. This is something that does happen in the therapy space. It’s important that I bring it up here because since we’re talking about therapists being attuned and being self-aware, being aware of transference and countertransference and when that’s happening is really important.
And the reason that it’s important for you to know about it is because this does happen. And when it happens, if the therapist is not aware, you are oftentimes reenacting stuff that happens, or that has happened in your life, that is actually not helpful.
Transference is referring to what happens when sometimes a client or a patient has a certain feeling about the therapist in front of them. For example, sometimes the therapist might remind them of someone that they disliked or that they actually had many problems with. Maybe of a parent that you have unresolved issues with. Other times, the therapist can remind the client of someone that they loved, or maybe of the parent that they would have wanted, or never had.
And so, when you start having these types of feelings towards your therapist and your therapist is not aware, or doesn’t address them, something called countertransference can happen. And countertransference, or some people pronounce it, countertransference, occurs when the therapist is not aware and has certain feelings back towards the person that they’re working with.
Feelings Towards Your Therapist
Let’s say, for example, that you are the client and you are starting to have feelings of feeling nurtured and feeling like your therapist is the sweet and kind and gentle father that you never had, or mother, and that you would have liked. And the therapist is not really aware of this. And that therapist has a countertransference to you where they are feeling very nurturing towards you and protective and feeling like almost like if you are a son or a daughter. And so the danger here is that boundaries may get crossed.
The therapist may start talking more about their own stuff and giving you advice or recommendations or nurturing in a way that not only is not helpful, but is confusing the relationship. And so that is something that can happen in the therapy space. And when this happens, boundaries, good boundaries are not set. And sometimes the limits that therapists should have in sharing personal information or doing some of the work for you that you should actually be doing does occur.
The other side of that spectrum is that sexual feelings can come up. Sometimes when we’re in a therapeutic relationship where you feel for the first time maybe in your life, you’re feeling like somebody is listening to you, that somebody cares, that you are for those 50 minutes, you are that soul person’s focus of attention and energy. That can feel not just validating, but it can also feel incredibly powerful and you might start developing sexual thoughts or feelings about that person.
And if that therapist again is not self-aware, they, being human beings, might make some very big errors and allow some of those boundaries to get crossed. So again, being aware of that power dynamic, and this is really more for my therapist friends, and we all know and talk about power dynamics, especially when you’re dealing with specific groups. Adolescents, LGBTQ, minority groups, and a difference in ages and also difference in gender or sex.
When you’re dealing with these differences, if you’re not aware, obviously therapy can make you worse in these cases. So what to look for? The first thing I want to say is, listen to your instincts. If you’re feeling like this is not a good fit for you, the therapist maybe is not a good fit personality-wise or clinically, or if you’re feeling worse on a regular basis after therapy.
You Should See Improvement Over Time
I’m not saying once in a while here, I’m saying just on a regular basis, and you’re not seeing any improvement in your mood or in your functioning as the weeks go by. If you’re not understanding why you’re doing what you’re doing in the therapy space. If your therapist is asking you to reflect on some things and you agree to it, but you’re not really sure why you’re reflecting on some things, that might be that the therapist is really not focusing on your goals, but rather focusing maybe on what they think you need.
Those are things that are really important and that if not addressed, can make therapy worse for you. The other thing too that is a really… It’s a tough one. This is a tough one because we develop relationships with people. And sometimes it’s hard to acknowledge that they may not be a good fit, but is your therapist trying to tell you that they are not a good fit for you or vice versa? Because he guess what, sometimes a therapist is not a good fit for you.
Sometimes you are not a good fit for the therapist. And it has nothing to do with whether you’re a good person or a bad person, or they’re a good person or a bad person. It just means that chemistry-wise, clinically, for whatever reason, they may not be a good fit for you. And if you continue to try to force the relationship that can make therapy make you worse.
Therapy Doesn’t Always Feel Good
In closing, I want to repeat here and debunk the myth that you’re supposed to feel great after therapy. Feeling bad in therapy does not mean that therapy itself is bad and that it’s making you worse. Again, growth is uncomfortable and you often do feel worse before you feel better.
But learning to listen to your instincts, learning to be able to communicate what’s happening in the space and in the room, and learning to advocate for yourself and what you need is one of the things that you can do to help therapy work for you. That’s all I have for you today. And as always, if you want to know more about our practice or this podcast, please be sure to head over to cohesivetherapynyc.com/podcast, to check out the show notes. There, you will be able to find resources, links and how to get in touch. Be well, everyone. And I can’t wait to see you again when I ask you, so how’s therapy?
About So, How’s Therapy?
In each podcast episode, Karen and her guests work to push through the traditional therapy format to demystify, debunk, and destigmatize therapy.
Whether you’ve been in therapy for years, or are thinking about reaching out, Karen is here to guide you through it all.
She tackles everything from Anxiety, Trauma and PTSD, to Childhood Emotional Neglect, to dealing with chronic illness, and everything in between, through the lens of her private practice in New York City, Cohesive Therapy NYC.
About the author(s)
Karen is the founder and Clinical Director of Cohesive Therapy NYC. She earned a Masters in Social Work from New York University and has extensive training in Hypnosis, Anxiety, Cognitive Behavioral Therapy, Brainspotting, and DGBI. She is a member of the Institute of Certified Anxiety Treatment Professionals, The Rome Foundation, the National Association of Social Workers, The Crohn's and Colitis Foundation, and the American Social of Clinical Hypnosis.