I think the adage just refers to the hitting bottom that happens to many clients who've decided to attempt therapy ((as a last resort often, because so many people have a stigma against mental health help and because it entails a comittment (to self)) and to the disillusionment and pain for some clients as they have to face head-on the things that were hurting them. In my case, PTSD, one of the symptoms is avoidance- a great example of how working through my defenses was very painful and exacerbated my symptoms, because I had invested something in numbing the pain of my experience. But after the worse, things did get tremendously better, so it made perfect sense to me, but certainly wouldn't need to be true of everyone, there are so many reasons folks are in therapy.