Why Do I Feel Worse in Therapy? And Am I Actually Making Progress?

Why meaningful change can feel uncomfortable, why longstanding patterns are difficult to change, and why progress may look different from what we expect.

Two questions come up frequently in longer-term therapy: Why do I sometimes feel worse since starting therapy? And why don’t I feel like I’m making progress?

Most people come to therapy because something in their life is not working. They may be struggling with anxiety or depression, repeatedly becoming triggered, experiencing difficulties in relationships, or finding themselves caught in patterns they understand but cannot seem to change. Understandably, they hope therapy will help them feel better.

So it can be confusing and disheartening to find that therapy sometimes feels uncomfortable, that familiar ways of coping seem stubbornly difficult to change, or that months into the process you are still being triggered by things you thought you had already “worked on”.

There are many different forms of psychological therapy, designed for different difficulties and with different aims, methods and expected timeframes. This article focuses specifically on longer-term, experiential therapies such as Schema Therapy and Internal Family Systems (IFS), particularly when working with childhood trauma, attachment wounds and longstanding patterns. If you are several months (or possibly even longer) in to this kind of therapy and wondering why change seems so slow, or why you sometimes seem to feel worse rather than better, this article is for you.

Feeling worse does not necessarily mean that therapy is working. Equally, slow or uneven progress does not necessarily mean that it isn’t. To understand either, we need more realistic expectations about what changing longstanding emotional and relational patterns can actually involve.

1. The ways we learned to cope are difficult to change for good reasons

When our emotional needs were not adequately met growing up, or we experienced relational wounds or trauma, we developed ways of coping that helped us adapt to the circumstances we were in. In Schema Therapy these are often understood through coping modes; in IFS, through protective parts. The terminology differs, but both approaches recognise that many of the patterns causing difficulties in adulthood developed for understandable reasons.

We might have learned to disconnect from our feelings, minimise our needs, please other people, strive for perfection, stay in control or become fiercely independent. We might use food, substances, dissociation, anger, overworking or other strategies to manage distress. These ways of coping can create significant problems in adulthood, but that does not mean they are pointless or irrational.

They still do something for us.

They may reduce emotional pain, create distance from vulnerable feelings, restore a sense of control, protect us from rejection or allow us to keep functioning when things feel overwhelming. The problem is that strategies offering effective relief in the short term can have significant longer-term costs to our wellbeing, relationships and lives.

This is one reason change is so difficult. In their book Reinventing Your Life, Young and Klosko describe longstanding patterns as deeply ingrained and write about how easily we can operate on “automatic pilot”, repeating familiar ways of thinking, feeling, relating and behaving that have been practised throughout our lives.

Therapy can begin to disrupt this established way of coping. We may become more aware of emotions and needs that our usual strategies have helped us manage, distance ourselves from or not engage with directly. At the same time, those familiar coping strategies may become more active. Someone might feel stronger urges to withdraw, dissociate, comfort eat, use substances, overwork, regain control or avoid therapy altogether.

This creates a paradox at the heart of experiential therapy. If we never get close enough to the vulnerable emotions, needs and experiences connected to our longstanding patterns, there may be little opportunity for new emotional learning. But approaching those experiences can activate the very ways of coping that developed to help us manage them.

So when someone says, “I know why I do this. Why am I still doing it?”, the answer is not simply that they have failed to learn the lesson. They are trying to change something that is familiar, automatic and still useful to them in some way.

I often use the analogy of an old pair of shoes. Your old shoes might be worn out and no longer particularly good for you, but they have moulded perfectly to your feet. They are comfortable, familiar and effortless to put on. A new pair may ultimately serve you much better, but initially they are stiff and unfamiliar and might even give you blisters.

When you are tired, stressed or overwhelmed, of course you are more likely to reach for the old pair.

The way new shoes become comfortable is by wearing them in. New ways of coping and responding also need to be experienced repeatedly before they can begin to feel as familiar and accessible as the strategies we have practised for years.

2. Meaningful change requires finding the workable middle

There is a phrase often used in therapy: you have to feel it to heal it.

There is some truth in this. We can develop considerable insight into why we think, feel and behave as we do without necessarily changing the emotional learning underneath it. Experiential therapies therefore involve more than talking about our experiences. Meaningful change often requires enough contact with the emotions, bodily sensations, memories and unmet needs connected to our longstanding patterns to relate to them differently.

Young and Klosko describe our natural tendency to move away from painful feelings and situations, even when approaching them may ultimately be important for change.

But this does not mean that more emotional intensity makes therapy more effective.

Too little: when therapy never gets close enough

If therapy remains entirely comfortable because we continually move away from anything emotionally difficult, our established ways of coping can continue largely unchanged. We might become extremely knowledgeable about ourselves, understanding exactly where our patterns came from, why we behave as we do and what we should do differently, while finding that the same emotional reactions continue to occur.

This is one of the reasons experiential therapies place importance on emotional learning rather than insight alone. At some point, there needs to be sufficient emotional activation for something new to be experienced, rather than simply understood.

Too much: when activation becomes overwhelm

The opposite problem can occur when painful experiences are approached with greater intensity or speed than the person currently has capacity for.

Someone who becomes completely overwhelmed may find it harder to remain present and engaged with what is happening. Familiar coping responses can become stronger precisely because they are doing the job they developed to do: helping the person regulate or escape intolerable distress.

This can leave someone wondering why they are suddenly dissociating more, withdrawing, becoming more controlling, relying more heavily on substances or food, or dreading their next therapy session. In some cases, it may contribute to people disengaging from therapy altogether.

Trauma clinicians have described this tension in different ways for decades: meaningful work involves approaching difficult emotional experiences while continually attending to the person’s capacity to remain sufficiently regulated and connected during that process.

The dance in the middle

I once heard the phrase “comfortably uncomfortable” used to describe this therapeutic space, and it has stayed with me.

Effective therapy is something of a dance between enough emotional activation for meaningful therapeutic work to occur and enough regulation to remain present and engaged in the process.

The therapist participates in this dance too. At different moments, a client may need more challenge or more support, greater emotional depth or some distance, encouragement to remain with an experience or an opportunity to pause. Janina Fisher describes the importance of therapists attending to both the regulating and dysregulating effects of the therapeutic encounter and adjusting what they are doing accordingly.

Linda Thai similarly emphasises that healing involves discomfort, uncertainty and some degree of risk, but within relative safety, relative connection and agency.  The aim is not to make therapy entirely comfortable, nor to see how much distress someone can endure. It is to gradually develop greater capacity for difficult emotional experiences without becoming completely overwhelmed by them.

Where that balance sits will differ from person to person. It may also change considerably over the course of therapy.

This is why feeling worse should never automatically be interpreted as evidence that therapy is working. A significant or sustained deterioration in wellbeing might mean the work is moving too quickly, that the approach needs adjusting, that circumstances outside therapy have changed, or that the therapeutic relationship or treatment itself needs reconsidering.

Feeling worse is information to be curious about, not proof either that therapy is succeeding or that it is failing.

3. Safety, trust and agency are part of the work

All of this can raise an understandable question: Why can’t we just get on with the deeper work?

For people who have experienced attachment wounds or relational trauma, the answer is partly that therapy is itself another relationship.

Someone may arrive in therapy with very good reasons for finding trust, dependence or vulnerability difficult and then be expected to sit with a relative stranger and talk about the experiences, emotions and needs they have spent years learning to protect.

As the therapeutic relationship develops, it can activate many of the same patterns that appear in other relationships. Feeling misunderstood, expressing a need, disagreeing, becoming angry, relying on the therapist, worrying about disappointing them or allowing the therapist to become emotionally important can all become significant.

This means that some of what appears to be delaying the “deeper work” may actually be the deeper work.

Someone who has always accommodated other people may tell their therapist for the first time that they are angry about something the therapist said. Someone whose safety has depended on fierce independence may gradually allow themselves to need support. Someone who expects disagreement to lead to rejection may discover that they can disagree, or that a rupture can occur, without losing the relationship.

These experiences may not look like dramatic therapeutic breakthroughs from the outside, but for someone with significant relational wounds they can represent something profoundly different from what they have learned to expect from relationships. Over time, repeated experiences of being understood, cared for, taken seriously and responded to consistently can begin to challenge expectations shaped by earlier relationships. In this way, developing safety and trust with the therapist is not simply preparation for the “real work”. The relationship itself can become part of the healing.

There is also an internal attachment repair that can take place. Experiential therapies such as Schema Therapy and IFS help us develop a different relationship with the parts or modes of ourselves that carry vulnerability, as well as those that have learned to protect us through different ways of coping. Instead of criticising, rejecting or trying to get rid of these parts of ourselves, we can become more curious about why they developed, more compassionate towards what they have been carrying, and more able to recognise and care for the emotions and needs underneath them. Gradually, vulnerable parts of ourselves can have a different experience internally: rather than being ignored, dismissed, shamed or left alone with their distress, they can increasingly be met with understanding, compassion, protection and care.

Both forms of attachment repair take repeated experience. Secure attachment develops through countless interactions over time, not through a single corrective experience. When someone has spent years learning that their emotional needs will not be noticed, understood or responded to—or that vulnerability, dependence or disagreement can threaten a relationship—it makes sense that developing different expectations of other people and a different relationship with vulnerable parts of themselves will take time.

Agency is also central to this process. Linda Thai uses the language of “voice and choice”: having meaningful influence over the pace and intensity of therapeutic work, including how deeply something is explored, when to pause and reconnect, and how frequently therapy occurs. For someone whose earlier experiences involved helplessness, lack of control or inescapability, having meaningful choices within therapy can itself be important.

Having agency does not mean that therapy should always remain comfortable, that the client should never be challenged, or that we only approach difficult material when we feel completely ready. Growth sometimes involves taking emotional and relational risks.

Rather, those risks can be taken collaboratively, with attention to the person’s current capacity.

Safety, trust and agency are therefore not simply preliminary steps to hurry through before the “real therapy” begins. For many people, developing them is part of the therapeutic work itself.

4. Change happens through repetition, not a magic therapy hour

Another reason progress can feel disappointingly slow is that we may begin therapy with unrealistic expectations about how psychological change happens.

Our experiences with other health professionals can understandably shape those expectations. We have a problem, see someone with expertise, receive a treatment and hope that the symptoms will improve. This model works well for many health problems.

Psychotherapy is different.

A therapist brings clinical knowledge, formulation, interventions and the therapeutic relationship. They can help make sense of patterns, provide new experiences, teach skills, challenge established beliefs and support someone in approaching things they have struggled to face alone. But a therapist cannot simply administer lasting psychological change during a 50-minute appointment.

There are 168 hours in a week. Even someone attending therapy every week spends approximately one of those hours with their therapist and the other 167 living their life. Fortnightly or monthly therapy increases that gap considerably.

And those hours contain the environments in which our longstanding patterns are repeatedly activated: relationships, families, workplaces, stress, conflict, loneliness, exhaustion and everyday responsibilities.

Physiotherapy offers a useful, although imperfect, comparison. A physiotherapist can assess a problem, provide treatment, teach new movements and adjust rehabilitation over time. But strength and mobility usually develop through what happens repeatedly between appointments. One rehabilitation exercise does not transform a muscle that has been weak for years.

Likewise, therapeutic change becomes established through repeated lived experiences. This does not necessarily mean formal “homework”. It might mean noticing a reaction slightly earlier, setting a boundary, allowing somebody to help, recognising a need, remaining with an emotion for a little longer, expressing disagreement, trying a different response or responding compassionately to yourself after falling straight back into an old pattern.

Young, Klosko and Weishaar use the term “empathic self-confrontation” for a stance towards change that combines compassion for why our patterns developed with an ongoing willingness to challenge them.

Understanding our history matters; so does taking responsibility for what we do with that understanding now.

This avoids two equally unhelpful extremes. We do not need to shame ourselves for struggling to change strategies that developed for very good reasons. But understanding those reasons does not mean waiting passively for our patterns to change by themselves.

Repeated experience matters because familiar responses have had an enormous head start.

One way of imagining this is as a path through the bush. The route you have walked thousands of times is clear and easy to follow. Creating a new path means initially pushing through scrub, and when you are exhausted or under pressure, the established route will naturally be easier to take. But repeatedly travelling the new path gradually makes it clearer and more accessible too. This is a useful way of thinking about neuroplasticity without assuming that a single insight somehow “rewires the brain”.

And when life becomes particularly difficult, the old path can become especially tempting. As Joanne Twombly puts it, “under stress we all tend to go back to early ways of coping.” 

Returning to an old reaction or way of coping does not mean that everything you have learned has disappeared. It means the old path remains very well travelled.

5. Maybe you’re making more progress than you think

This brings us to perhaps the most important question: How do we know whether therapy is actually helping?

Part of the difficulty is that we often use an unrealistic definition of progress.

If recovery means I will never be triggered again, I will never experience painful emotions, I will never use an old way of coping, or nothing will bother me anymore, almost everyone will eventually conclude that they have failed.

Schema Therapy offers a more realistic way of understanding change. Schemas may not disappear altogether. Instead, as they heal, they can become activated less frequently, less intensely and for less time, while the person becomes increasingly able to respond differently when they are triggered.

This gives us four useful dimensions for noticing change:

Frequency. Intensity. Recovery. Response.

Perhaps you still become deeply hurt when you experience rejection, but it happens less frequently. Perhaps you are triggered just as often, but the intensity has shifted from a nine out of ten to a seven. Perhaps the reaction is still a nine, but what once consumed several days now settles within hours.

Or perhaps the trigger itself has barely changed, but your response has.

You recognise what is happening sooner. You understand why it has affected you so strongly. You can notice the urge to use a familiar way of coping rather than immediately acting on it. You might still use it sometimes, but you have a moment in which another option becomes possible.

That moment matters.

Cece Sykes’ Spectrum of Self provides a useful way of thinking about this kind of incremental change. If someone ordinarily becomes completely consumed by an emotional state or protective reaction, progress does not require suddenly becoming permanently calm and centred. Moving a few centimetres along the spectrum towards greater awareness and choice can be meaningful progress.

Progress can also appear in places that are harder to measure: greater self-compassion, increased ability to recognise and express needs, being able to receive support, trusting another person more, recovering from conflict differently, remaining present with an emotion for longer, or being able to pause before reacting automatically.

And sometimes progress means greater capacity. Something may still hurt just as much initially, but you can remain connected to yourself while it hurts. You have more ways of regulating yourself. You can ask for help. You no longer need to make the feeling disappear immediately.

Progress also involves flexibility.

Therapy is not necessarily about replacing one supposedly “bad” reaction or way of coping with one permanently “good” one. Sometimes anger is appropriate. Sometimes stepping away is wise. Sometimes we need independence; at other times, allowing ourselves to depend on someone is healthy. Sometimes accepting discomfort serves us; sometimes changing or leaving the situation does.

What changes is that we become less reliant on one automatic reaction or familiar way of coping. We develop a broader repertoire and become increasingly able to respond to what is actually happening now, rather than having the past automatically determine what we do next.

Healing is also rarely linear. Stress can reactivate familiar ways of coping. Relationships change. Life happens. New difficulties emerge. Sometimes increased awareness means we notice patterns that were already there and mistakenly conclude that we have become worse.

Even positive experiences can initially feel unfamiliar. Frank Anderson has written about people with relational trauma finding happiness, closeness or things going well surprisingly uncomfortable because these experiences do not fit what their history has taught them to expect. Adjusting to a new way of being can itself take time.

None of this means that we should explain away genuine deterioration as part of the healing process. If therapy is leaving you persistently overwhelmed, your symptoms are significantly worsening, you do not feel safe with your therapist, or you are concerned about how the therapy is affecting you, those experiences deserve to be discussed rather than automatically reframed as “progress”.

But neither does being triggered again mean that you are back where you started.

The patterns we bring to longer-term therapy may have been rehearsed across decades. They often developed for understandable reasons, continue to provide short-term relief and are embedded in how we relate to ourselves and other people. Changing them requires emotional experience as well as insight, enough safety and trust to take meaningful risks, repeated opportunities to respond differently, and compassion for the many times we will still reach for the old pair of shoes.

Perhaps progress in long-term therapy is less about reaching a point where nothing difficult affects us and more about gradually developing greater capacity, flexibility, freedom and choice in how we respond when it does.