Individual Counseling

Exacerbation

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There is a typical sequence for most people who go to therapy and understanding it might be useful for you. These stages hold most true for people who take the process very seriously and are giving everything they have to improving their lives.

I think the best word to describe the beginning is elation. The first few sessions are similar to the honeymoon period of romantic relationships. Just deciding to get help usually lowers anxiety and provides a sense of purpose and hope. Even though there hasn’t been any actual movement, hard work, introspection, changes in cognition, or changes in lifestyle people still feel much better because they believe they will feel better, and also because they are motivated and doing something.

The first few sessions are also usually quite powerful because most have a great deal to get off their chests and they may not have shared any of it with anyone before. Think of holding your breath until you are about to burst, and then imagine that feeling of release when you finally exhale. Imagine having symbolically held your breath for years or even your entire life. Getting the chance to unload to a concerned, non-judgmental person whose only purpose is to try to help you can create feelings of connection and elation right away.

But all honeymoons come to an end. The novelty wears off and the hard work begins. At times the therapist stops seeming like a friend and begins to resemble an adversary. Instead of getting better, your symptoms start to exacerbate and you actually start feeling worse. This is completely normal and happens to a lot of people. You can train your brain to take it as a sign that therapy is working and is actually going well, as backwards and ironic as this sounds.

There is a pretty simple reason why symptoms tend to exacerbate once the relationship is established and the hard work begins. All of us build our lives on a house of cards to some extent. We come up with rationalizations and excuses to help us deal with the more difficult parts of our lives. We lie to ourselves, and on some level we know we are lying. This creates psychic conflict, and we feel compelled to tell ourselves more lies to smooth over this conflict. We all get good at constructing a fabrication that most of the people around us accept and don’t question too much, but if the counseling relationship is worth anything and the therapist knows what he or she is doing then these rationalizations will not work during a session. The therapist keeps pushing and delving, not accepting the ready-made answers, peeling away some of the armor to expose the soft underbelly that we all work so hard to cover up.

This is one of the secrets to understanding why so many people believe they are getting worse even though from an objective standpoint they are making good progress. Raising your conscious awareness before entering therapy will save you a lot of grief and give you hope when you are feeling like quitting. It’s important to note that not all cases are the same, there are bad therapists out there and some people really do get worse, but as a general rule if you take counseling seriously you can expect an exacerbation of symptoms for a while. There is a light at the end of the tunnel and if you stay dedicated and focused chances are that good things will happen.

Greetings I'm Michael, the owner of Evolution Counseling and the author of all the articles on this site. I got my master's degree from Seattle University in community mental heath counseling and have committed myself to advancing my knowledge of psychology and to evolving my own philosophical system ever since. In addition to the content on this site I offer online coaching using Skype. If you'd like to learn more about it click on the online coaching tab or if you think you'd like to set up a session send me an email at evolve@evolutioncounseling.com.

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