Must things get worse before they get better?

It's often said on this forum and on therapy internet sites that in therapy things have to get worse before they get better. Part of me sees some logic in this, depending on what you go to therapy for, but part of me wonders if it isn't just a way to justify a common phenomenon, namely that clients who seek out therapy often feel worse. (I'm not saying therapy should make you feel better right off the bat, or even at all, I'm asking why primum non nocere ("first do no harm") doesn't apply throughout the process.)

The poll is just about whether you believe this principle, not whether things have actually gotten worse for you due to therapy, though you can post about that if you like. For me, things have gotten worse since I started therapy, but it's not linked to therapy - serious health concerns and a spouse overseas will do that for you.

I voted not sure. I guess some people may not experience the "worse before better" phenomenon, but I definitely did. It was something I wasn't expecting. And my T was quick to say it happens to a lot of people. I think talking about deep, dark things in our lives tends to magnify our feelings of depression, etc. Just my experience.

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.

I voted 'other' because I think it ultimately depends on how deep the issues go. I do think for the most part though that yes, things get worse before they get better. Working with core problems can cause great suffering.

I voted yes. With my therapy things were a lot worse and have now finally gotten better. I am glad I decided to stick with it instead of giving up when it started out rough.

I like the question. I think it is possible that the idea of getting worse when you start therapy can justify ineffective or bad therapy. For me, my first therapy experience made me feel pretty lousy. Now I have settled with a new T, I've been seeing her for a few months, I'm finding that I don't feel lousy. My therapy isn't easy, but I feel at peace between sessions. (At the moment anyway, could be a passing phase).

I don't think it must - I think it is a phrase used to more justify how therapy is just stab and guess on the part of therapists and it deflects the blame from their bumbling when it happens than to explain how the getting worse is beneficial to the client. Perhaps not always, I am certain someone can come up with an exception, I just believe often.

If things are getting worse, then they must eventually get better. So says the T.
If things are getting better, it's because of the relationship between the T and the client and therapy must be helping. So says the T.

Can you imagine a skin doctor, or a gastroenterologist making this argument? Your rash has crept up your neck, covered your face and is heading towards your eye sockets, proof that it must eventually resolve?

I don't see it like that at all- it's more like *feeling or believing* things are better than they are, less like a rash that spreads than a biopsy that reveals a tumor is larger than we would've guessed. You may not've felt any pain from the cancer, but the chemo is a *****.

My 'worse' was not wanting to own pretty much any of my first 18 years, because they were so damned painful. I went on, like I had no past whatsoever, until all the anger and feeling of being out of control surfaced when I had difficulties mothering. Buying them back in order to defuse my triggers and gain clarity, made things hurt more before they got better. But therapy didn't create the pain or injury, it revealed them, more like draining pus from a deep wound.

"Not sure", because I really don't know that I believe things ever really get better. "Getting better" for me is like making my way up to a higher circle of Hell than I was in previously.

In a class of mine we recently went over research on effective therapy. There aren't many, but studies do show that when therapy works, clients tend to improve sooner than later. So with this in mind, the theory that things must get worse before they get better may just be a way to explain away therapy that simply isn't working.

That would still be relative though- if things improved in 6 weeks, the worse could be the first two or three, if things improved in a few years, the worse could be the first years.

Also, those few studies are measuring certain types of limited outcomes in relatively short term studies, so I'm not sure they're too applicable to a bigger picture analysis of this, perhaps to folks who go with CBT or something, for specific concerns.

Also, depending on the term, clients could be enjoying the honeymoon phase of therapy where the relief at getting help and having someone to unload on feels like an improvement, but is not all there's going to be in terms of the work or progress which often comes later.

I get a bit concerned about study generalizations when links to the studies or specific detail isn't provided. A link to a meta-analysis is even better.

I think people entering therapy, virtually by definition, have something that isn't working... and facing that and learning how to change often entails difficulties, otherwise, a simpler, more common intervention would've worked.

P.S. I don't think worse before better must be taken as an all-or-nothing experience. For example, a sense of lonliness or alienation may decrease upon confiding in a therapist while a sense of disillusionment about the struggle that brought one there may increase as we discuss it, just one possible permutation. I think another adage, that change is stressful, applies, even with good change!

They don't get worse. They feel worse.

That may be what is actually meant, but it is usually expressed as "get worse," including on these forums.

Yes, so the answer to your question is that. Things don't get worse. They're experience a feeling worse.

I honestly was too tired to look up the study again. It was part of a class presentation so I don't have names or links on me personally, but I can look them up.

I'm sure it varies for everyone so I shouldn't have use such definitive language in my initial response. The studies are definitely based on short term therapy, mostly because the majority of clients don't stay for longer term therapy.

I said "no" because I don't think they *must* get worse before they get better. I suppose they could for some people but I don't think it's a requirement. I personally haven't had that experience.

I've been thinking about this question today. When I was having therapy with my ex T I felt terrible. I re-experienced some horrible childhood feelings. My ex-T was kind of thrilled that I was feeling my feelings. The thing is it was a repeat of my childhood, I coped with those feelings all by myself again. I think that there is a theory that it is helpful to feel those feelings, but I don't think that what happened with my T helped. With my new T I feel held, so I'm not that lonely child again. I'm not feeling so terrible, I'm actually feeling quite good at the moment. I'm starting to question whether it is necessary to feel terrible feelings to have successful therapy.

No...sometimes things actually do get worse. It may be because things feel worse (chicken-egg argument here) - but not only did I end up feeling worse, tangible things in my life got worse because of it.

I agree with a lot of the sentiments here that the adage is an excuse. I went from someone with moderate but constant depression and anxiety to someone with severe depression and anxiety (and constant suicidal thoughts) during therapy. I believe it was because my therapist was not experienced in dealing with trauma and I was being unintentionally retraumatized. I know now that there are "methods" that are not traumatizing and that healing is possible without that level of pain. That's not to say it can be uncomfortable - I'm ok with the discomfort of stretching my beliefs and boundaries - but I think the level of agony some folks (myself included) feel during therapy is not necessary.

I agree with this. I got retraumatized in my first round of therapy. I don't think it had to happen - my first therapist was working very hard and was sincerely trying to help but his method just didn't allow for the kind of help I needed. My current therapist's style stresses all sorts of ways of taking care of myself, and it's very much about building up my ability to manage my emotions in the face of post-traumatic responses. It's so much healthier for me, and I wish I had never gone though that destructive first round of therapy.

I wish this wasn't something that's told to people. It's too ill-defined and easy to use as a cop out for poor therapy (on both sides). I've mostly only ever gotten worse. This is the first time I have ever seen any progress, and I started to see it pretty early on, even though it's been small progress. Even if some things get worse, I think there should also be signs of things going in the right direction.

This is what I meant from my earlier post. From what I'm learning, if therapy is going to work, it's evident pretty early on. There will of course be cases where this might not be the case but I tend to think "it gets better before it gets worse" is mostly a cop out by therapists who aren't very effective.

I don't think knowing the therapy is going to work is mutually exclusive with things feeling a lot worse before life gets a lot better.

Completely agree with this. With the good therapists I've seen, I've always been able to see very early on that my therapy was going to move me in the right direction. That didn't mean it wasn't at times horrendously painful to expose what was ailing me. At times I absolutely did become more depressed, etc., but even then, I still felt things were moving forward. I would come out of those episodes (which are part and parcel for my diagnosis), feeling like even though I had just been through the wringer I was still making progress and learning and healing -- just very slowly at times.

Therapy hasn't been very linear for me. It's been more like a rocking chair going back and forth, sometimes in small, fluid movements, sometimes in such large movements I pretty much tipped over; but, I have always been able to right the chair and get back in rhythm.