“Sometimes you get worse before you get better” is one of the cliches mostly used in psychodynamic therapy.
I heard those words from my therapists every time I complained about feeling worse, and many therapy clients have heard the same idea. It might have been expressed slightly differently but it carried the same message, which is that healing can start only when people face their pain and deal with it.
Let me first say that I fully subscribe to the idea that addressing emotional pain and all its surrounding darkness and toxicity is unavoidable in most (not all) cases of trauma, no matter how intense the pain may be, if one is serious about their healing.
When the pain of past and present traumatic experiences remains suppressed for many years, it holds up a tremendous amount of life energy that we could otherwise use for enjoyable and fulfilling activities. It is only when the pain is released, our energy frees up and becomes available for us to use for everything constructive. But it’s impossible to release it without feeling it and, so, like it or not, painful feelings will come to surface during therapy in many (again, not in all) cases.
In that sense, the statement “sometimes you get worse before you get better” accurately describes some stages of a healing process.
The problem with this concept is not the concept itself, but how it has been practically implemented by professionals. So far, its implementation, in my view, has failed miserably due to the fact that the existing therapy training doesn’t provide a solid understanding of trauma rooted in brain and body research. Instead, outdated theories and unfounded assumptions are being falsely presented as scientific facts upon which practitioners base their so-called “treatment” methods. No wonder then why their methods fail.
One of the incorrect assumptions many therapists operate from is that “no one dies from too much crying”, which is another way of saying that any type of traumatic material can be addressed head on and no precautions need to be taken when working with trauma. This assumption is not only incorrect but also very dangerous.
First of all, there ARE instances when a sudden heart attack or a stroke was triggered by having to deal with too much emotional pain at a time. The amount of pain that bursts into a person’s conscious awareness may sometimes be so massive and its intensity so great that some of the systems or organs in the body may shut down because the body is unable to process it all at once. I don’t know how often it happens because I couldn’t find any statistical data on that. I would think that the risk of it happening depends on the severity of traumatic experiences, but if the risk exists professionals must be aware of it and take that risk into account.
Secondly, the danger to patient’s life doesn’t just come from the risk of pushing the limits of the body’s natural capacity to work in sync with mental processes. In most cases, trying to work with too much traumatic material too fast may shake patient’s mental stability that might not have been great to begin with when they started therapy. The innate mechanism of emotional self-regulation may be so undermined by the attempt to deal with a lot of pain at once that it can drive someone to suicide, and, even when the tragedy is avoided and the person gets immediate help, bringing someone to that point is unjustifiable.
Just like it is unjustifiable to be dismissive of the fact that processing traumatic pain may trigger non-suicidal self-destructive and risky behaviors in traumatized individuals. By their risk level they vary from the ones that cause gradual long-term self-harm such as substance abuse to the ones causing immediate self-injury like cutting to the ones causing serious bodily injury to the self or others or destruction of property (reckless driving, driving under influence, road rage, assault etc).
All of the above is something every therapist should be mindful of when working with trauma.
The therapist must be very attuned and respectful of the client’s current emotional state and their emotional capacity to process pain at each given moment. Failure to do so may result in exacerbating an already existing trauma and in some cases it may result in tragedies such as self-harm, suicidal attempts and, in extreme cases, sudden failure of some bodily functions due to the overwhelming stress. Forcing someone to get in touch with disturbing and painful emotions when they are not ready to do so is dangerous, is not consistent with the findings of neurological trauma research and, in my opinion, it constitutes a professional malpractice.
Another example of professional ignorance and negligence would be a failure to create conditions of safety for processing traumatic material. This could be literally compared to not using helmets and other safety equipment on a construction site or any other workplace where the risk of injury is high. When mental trauma comes to surface, it can get intense and potentially explosive, which calls for mandatory safety standards and safety training that currently don’t exist.
Prominent mental health practitioners and researchers like Dr. Van Der Kolk, Peter Levine, Francine Shapiro, Babette Rothchild and others, who dedicated their cereers to understanidng trauma and finding better methods to treat it, suggest that creating conditions of safety is paramount for processing traumatic material. The more severe the trauma, the more time and effort should be put into establishing safety for therapy process to move forward.
Last, but not least, talking about traumatic experiences is not the only method of trauma recovery and may not be the most effective method in many cases. There are newer therapeutic modalities such as somatic experiencing and neurofeedback that attempt to work with trauma on a much deeper physical level without the need to talk about it and to go through emotional turmoil.
There is also EMDR (Eye Movement Desesitization and Reprocessing) therapy, which stands somewhat in between talking and non-talking modalities. It does involve recalling and relaying traumatic memories, but, in that model, this is done while the patient keeps their eye gaze fixed on the object that goes from side to side like a pendulum or listens to binaural sound that goes through the headset back and forth from one ear to another. This way the emotions and the body sensations are synchronized, which makes emotional processing safe because it keeps the patient rooted in the present while he or she is recalling disturbing events.
I believe, the newer modalities that get the brain and the body actively involved in the healing process will become more mainstream in the future, because they have demonstrated their safety and higher effectiveness. More research is needed, of course, but these, I believe, are some of the trauma treatments of the future.
In conclusion, I’d like to reiterate the same message I convey to my readers over and over again throughout my writings: you are a consumer and you are in charge of your therapy.
If your therapist has ever said to you that you need to get worse before you get better, just know that the “getting worse” part should always be just a means to a certain end.
“The end” a.k.a the goal of therapy for you not only to feel better (because feelings are transient and no one can feel great all the time) but to GET better.
Getting better means that you have found a greater sense of fulfillment in your life which stays with you no matter how you feel in the moment and no matter what kind of challenges life throws your way. It means that your overall quality of life has improved since the beginning of therapy.
I could list many signs indicating that a client is getting better, but they will always vary depending on a person. Only you can define what getting better means to you, but, whatever it is, this is what you should be getting gradually but steadily in therapy.
The “getting worse before you get better” parts of a healing process should feel either as a necessary cathartic release of pain, which is always brief, or as a temporary setback, which gets worked through with the therapist’s support and guidance.
As I mentioned before, healing is not an easy and linear process in which you consistently feel better. Some stages of that process are painful and there could be some periods of darkness before the light of hope shines again and fills you with energy. This is what the expression “getting worse before getting better” refers to.
But no matter how dark and painful it may get for you sometimes, you should always feel that your therapist “has got your back” and that he or she is committed to helping you regain your balance and is consistently directing your process towards recovery.
The “getting worse” stage should never become a chronic condition. If you experience a continuous emotional deterioration that seriously affects your daily functioning and the therapist doesn’t seem to take your complains seriously, that therapist doesn’t have your back. If they respond to you with general words about how everyone’s individual process is different and how there is no precise time frame for things to get better while showing no interest in helping you restore your mental stability and regain your strength, waste no time on them and run away before your emotional damage is too great to fix it.
Always trust your common sense more than any therapist’s expertise. Their expertise is relative and subjective and it is certainly ok to question it. This was one of the greatest lessons I learned from my therapy experience and it has come in handy many times in my life.
In conclusion, I’d like to re-iterate the same message I try to communicate to my readers throughout my writings. You are a consumer. You get to call the shots when it comes to the service you are recieving.