I Feel Worse After Therapy Sessions - And Why That's Not Always "Growth"
You leave therapy feeling more anxious, depressed, or confused than when you arrived. When you mention this to your therapist, they reassure you that "therapy gets harder before it gets better" or that feeling worse means you're "making progress." But here's what research on adverse effects in psychological treatment reveals: many clients report negative or harmful effects from therapy, and while some emotional discomfort is inherent in therapeutic work, consistently feeling worse after sessions may indicate problematic treatment approaches rather than normal healing processes.
Understanding the difference between therapeutic growth discomfort and harmful therapy effects, why you're psychologically wired to blame yourself when treatment makes you feel worse, and how to distinguish between necessary emotional work and damaging therapeutic approaches can help you advocate for treatment that truly serves your healing.
The Research: When Therapy Becomes Harmful
Up to 94% of clients have reported that they experienced “adverse treatment reactions” during therapy. This includes, “experience of unpleasant memories (57.8%), unpleasant feelings (30.3%) and a lack of understanding of the treatment/therapist (19.3/18.4%).” Between 5% and 20% of clients are “worse off” after therapy, according to studies cited by the American Psychological Association.
The term for this is “iatrogenic”, describing something "brought forth by a healer" referring to the harmful effects of medical care. And it’s why you have reason to be concerned if you consistently feel worse off after therapy sessions.
Why Your Brain Blames You for Bad Therapy
Here's the psychological vulnerability that makes harmful therapy particularly damaging: the very conditions that brought you to therapy—depression, anxiety, trauma, low self-esteem—make you more likely to assume that negative experiences are your fault rather than questioning whether the treatment approach is appropriate. If you're dealing with depression, your brain is already primed to interpret negative events as evidence of your personal inadequacy.
Research on people with anxiety disorders shows they often become hypervigilant to their own perceived "failures" in therapy, interpreting emotional distress as proof they're not working hard enough or aren't "good at" therapy. When sessions consistently leave you feeling worse, your anxious brain may conclude that you're resistant, unmotivated, or too damaged to be helped.
The therapeutic relationship creates unique vulnerability because you're in a position of seeking help from an expert. When that expert's treatment makes you feel worse, your brain may assume the problem lies with your inability to benefit from their expertise rather than considering that their approach might be wrong for your needs.
How to Tell the Difference: Growth Discomfort vs. Harmful Effects
Signs of Healthy Therapeutic Discomfort:
Temporary and supported distress:
Feeling sad or anxious during sessions but gradually better afterward
Emotional intensity that feels manageable with your current coping skills
Discomfort that leads to new insights or understanding about yourself
Difficult feelings that feel connected to specific therapeutic work rather than general destabilization
Your therapist helps you process and integrate difficult emotions during sessions
Progress indicators:
Even when sessions are hard, you feel somewhat hopeful about your healing
You develop better understanding of your patterns or triggers over time
Coping skills and emotional regulation generally improve between sessions
Relationship with your therapist feels safe and supportive even when content is difficult
You can identify specific areas where you're growing or changing
Appropriate pacing:
Difficult material is introduced gradually at a pace you can handle
Your therapist checks in about your emotional state and adjusts accordingly
You feel like you have some control over the depth and timing of emotional processing
Sessions end with some sense of closure or stabilization rather than raw emotional exposure
Signs of Harmful Therapy Effects:
Consistent deterioration:
Regularly leaving sessions feeling more anxious, depressed, or hopeless than when you arrived
Sleep problems, appetite changes, or physical symptoms that worsen on therapy days
Increased suicidal thoughts, self-harm urges, or destructive behaviors since starting therapy
Feeling more confused about yourself or your situation rather than gaining clarity
Loss of hope about your ability to heal or improve
Emotional overwhelm:
Sessions consistently push you beyond your emotional capacity to cope
Being expected to process traumatic material before you feel ready or safe
Therapist dismisses your requests to slow down or approach topics differently
Leaving sessions feeling emotionally "flooded" or unable to function normally
Therapy triggering panic attacks, dissociation, or other trauma responses
Relationship problems:
Feeling worse about yourself as a person since starting therapy
Increased shame, self-criticism, or self-doubt
Therapist making you feel judged, criticized, or fundamentally flawed
Sessions that feel more like interrogation or criticism than supportive exploration
Growing fear or dread about attending therapy appointments
What to Say When Therapy Consistently Hurts
Script for addressing pattern with your therapist: "I've been noticing that I consistently feel worse after our sessions—more anxious, depressed, or hopeless than when I arrive. I understand that therapy can be difficult, but this pattern is concerning me. Can we talk about whether our approach is working for me?"
When they dismiss your concerns: "I appreciate that you believe feeling worse is part of the process, but I need us to examine whether the level of distress I'm experiencing is actually helpful for my healing. The current approach doesn't feel sustainable for me."
If they insist you need to push through: "I understand that growth can be uncomfortable, but I'm experiencing deterioration in my daily functioning since we started this approach. I need us to modify our methods so I can participate in my life while doing therapeutic work."
When considering whether to continue: "I've been in therapy for [time period] and I'm consistently feeling worse rather than better. I need to understand whether this is genuinely helpful for my specific situation or if we should try a different approach."
When Good Intentions Create Bad Outcomes
Therapists genuinely want to help and aren't intentionally causing harm. However, good intentions don't prevent therapeutic approaches from becoming damaging when they're inappropriate for your specific needs, poorly timed, or executed without adequate training and supervision.
Research shows that therapists sometimes mistake emotional intensity for therapeutic progress, believing that if clients are crying or expressing strong emotions, the therapy is moving forward. However, studies indicate that emotional catharsis without proper integration and support can actually increase rather than decrease psychological distress.
Protecting Yourself from Harmful Therapy
Monitor your overall functioning: Keep track of your sleep, appetite, relationships, work performance, and general mood patterns. If these areas consistently worsen on days you have therapy, this suggests the treatment approach may be problematic.
Trust your nervous system: If you find yourself dreading therapy appointments, feeling physically ill before sessions, or having trauma responses during or after therapy, your body is giving you important information about the treatment's impact.
Seek outside perspectives: Talk to trusted friends, family members, or other healthcare providers about how you've been doing since starting therapy. Sometimes outside observers can see deterioration that you've normalized.
Document concerning patterns: Keep brief notes about your emotional state before and after sessions, significant events during therapy, and your overall progress (or lack thereof). Patterns become clearer when documented over time.
Troubleshooting Common Scenarios
"My therapist says I need to feel worse before I feel better" While some discomfort is normal, consistent deterioration isn't therapeutic. Try: "I understand that growth can be uncomfortable, but I need to see some signs of improvement or stability. How long should I expect to feel worse before seeing positive changes?"
"They say I'm being resistant when I object to their methods" This can be a manipulation tactic. Address it: "I'm not being resistant—I'm giving you important feedback about how your approach is affecting me. I need a therapist who can adapt their methods to what works for my healing."
"I'm told that wanting to feel better is 'avoiding the work'" This is concerning language. Consider: "My goal in therapy is to improve my quality of life and mental health. If your approach consistently makes me feel worse without corresponding improvements, then it's not working for me regardless of the theory behind it."
"They insist their method is 'evidence-based' so it must be working" Evidence-based doesn't mean universally appropriate. Say: "Evidence-based approaches still need to be tailored to individual clients. The evidence for me is that I'm getting worse, not better, so we need to adjust our approach."
Taking Charge of Your Healing
Your responsibility:
Monitor and communicate how therapy is affecting your overall functioning
Advocate for approaches that feel emotionally manageable and productive
Seek second opinions when therapy consistently makes you feel worse
Trust your instincts about what feels helpful versus harmful
Their responsibility:
Adjust treatment methods based on your response and feedback
Ensure their approaches are appropriate for your specific conditions and history
Monitor your overall progress and modify treatment when you're not improving
Maintain adequate training and supervision for the populations they serve
When to modify the approach:
You're experiencing some benefit but the intensity feels overwhelming
Your therapist is willing to adjust their methods based on your feedback
The therapeutic relationship feels safe even when the content is difficult
You can identify specific aspects of the approach that are problematic
When to consider ending or changing therapists:
Consistent deterioration in your functioning despite addressing concerns
Therapist dismisses or pathologizes your feedback about feeling worse
You dread therapy appointments or have trauma responses to sessions
No improvement after several months of consistent therapy attendance
The Bottom Line: Healing Should Feel Healing
Feeling consistently worse after therapy sessions isn't a normal or necessary part of the healing process. While authentic therapeutic work can involve temporary discomfort, effective therapy should generally leave you feeling supported, hopeful, or at least emotionally contained, even when addressing difficult material.
Don't let anyone convince you that feeling progressively worse is evidence of therapeutic progress. While growth can be uncomfortable, healing should feel fundamentally different from the trauma, neglect, or emotional damage that brought you to therapy in the first place.
Trust your experience, advocate for approaches that feel genuinely helpful, and don't settle for therapy that leaves you feeling more broken than when you started. Effective, supportive therapy exists—and recognizing harmful treatment is the first step toward finding healing approaches that truly serve your wellbeing.
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