When Therapy Makes You Feel Worse: A Practical Guide

When therapy makes you feel worse, the first question is whether you are experiencing temporary emotional discomfort from discussing difficult material, or a genuine decline in safety, functioning, or trust. Some sessions can stir up sadness, anxiety, anger, fatigue, or memories. That does not automatically mean therapy is harmful. But worsening symptoms, feeling pressured, losing daily functioning, or repeatedly leaving sessions destabilized without a plan deserves prompt attention.

The right response is not to force yourself to continue silently or to conclude that all therapy is bad. It is to slow down, describe what is happening, assess risk, and decide whether the issue is pacing, approach, therapeutic fit, or the need for a different level of care.

Why therapy may feel worse at first

Therapy often asks people to pay attention to experiences they have avoided, minimized, or never described aloud. That can create a short-term increase in emotional intensity. Common reactions include:

• feeling tired after a session;
• noticing more anxiety because you are tracking it more closely;
• sadness after discussing grief or loss;
• anger about past treatment by others;
• uncertainty while old coping patterns are changing;
• temporary discomfort while practicing exposure or new behavior.

A difficult session is not necessarily a bad session. The important questions are whether the work has a clear rationale, whether you gave informed consent, whether the pace is tolerable, and whether the therapist helps you regain stability.

Temporary discomfort versus harmful deterioration

Temporary therapeutic discomfort is usually understandable, limited, and connected to a treatment goal. You may feel stirred up, but you can still function, use coping skills, and discuss what happened openly.

More concerning deterioration tends to look different. Warning signs may include:

• symptoms becoming steadily more severe over several weeks;
• frequent panic, dissociation, insomnia, or emotional flooding after sessions;
• new or stronger thoughts of self-harm;
• inability to work, study, parent, sleep, or manage basic responsibilities;
• feeling shamed, blamed, intimidated, or manipulated by the therapist;
• pressure to disclose or revisit material before you feel ready;
• the therapist dismissing your report that treatment is making you worse;
• unclear goals, no progress review, and no plan for adverse reactions;
• boundary violations, secrecy demands, financial pressure, or dependency-building behavior.

The distinction is not based only on whether therapy is emotionally hard. It is based on safety, consent, functioning, and whether the process remains collaborative.

What to do when therapy makes you feel worse

1. Describe the change in concrete terms

Instead of saying only “therapy is making me worse,” record what changed:

• What symptoms increased?
• When did the change begin?
• How long does it last after each session?
• What happens to sleep, appetite, work, relationships, or concentration?
• Is there a particular topic or intervention that triggers it?
• Are you able to recover before the next session?

Specific observations make it easier to distinguish a temporary reaction from a treatment problem.

2. Tell the therapist directly

A competent therapist should be willing to discuss negative reactions without becoming defensive. You might say:

“I have noticed that after the last three sessions, I cannot sleep and my anxiety stays elevated for two days. I need us to review the pace and the plan.”

Useful follow-up questions include:

• What is the purpose of the current technique?
• Is this reaction expected?
• How will we measure whether I am improving or deteriorating?
• Can we slow down or add stabilization work?
• What should I do between sessions if symptoms spike?
• At what point would you recommend a different approach or provider?

NIMH recommends discussing goals, time frame, progress measurement, and what happens when improvement is not occurring.

3. Revisit the treatment plan

A treatment plan should not be static. It may need changes in:

• session frequency;
• pace of trauma processing;
• emphasis on stabilization and coping skills;
• therapeutic method;
• medication review;
• coordination with a physician or psychiatrist;
• level of care;
• the therapist-client match.

A mismatch does not mean you failed. A therapist may be skilled but not suited to your condition, communication style, culture, goals, or current level of stability.

4. Seek a second opinion when needed

A consultation with another licensed professional can help clarify whether the current reaction is expected, whether the method is appropriate, and whether another diagnosis or medical factor should be considered.

A second opinion is especially useful when:

• your concerns are repeatedly minimized;
• you feel afraid to disagree with the therapist;
• symptoms are worsening rapidly;
• the treatment rationale is vague;
• there are boundary or ethics concerns;
• you are unsure whether to stop abruptly.

5. Do not discontinue medication abruptly

If therapy is occurring alongside medication, contact the prescribing clinician before changing the medication. Mood, anxiety, sleep, agitation, and concentration can be influenced by medication effects, dosage, withdrawal, substances, or physical health conditions.

When immediate help is needed

Seek urgent support if you may harm yourself or someone else, cannot maintain basic safety, are experiencing psychosis or mania, or are rapidly losing the ability to function. In the United States, call or text 988 for crisis support, or call emergency services when there is immediate danger.

Do not wait for the next routine appointment if risk is escalating.

Should you stop therapy?

Sometimes pausing or ending therapy is reasonable. But the safest way to do so depends on the situation.

A planned transition may include:

• one session to review what happened;
• a written summary of goals, progress, and concerns;
• referrals to other providers;
• a safety plan;
• transfer of records with consent;
• coordination with a prescriber;
• a short period focused on stabilization rather than intensive processing.

Leaving immediately may be necessary when there is abuse, exploitation, serious boundary violation, or immediate danger. In less urgent situations, a structured transition can reduce disruption.

For a broader review of treatment-related harm, see When Therapy Makes Things Worse. For a troubleshooting framework, see Therapy Not Working: What to Check Before You Give Up.

Practical takeaway

Use this three-part test:

1. Safety: Am I more at risk, less stable, or less able to function?
2. Collaboration: Can I raise concerns without being dismissed or punished?
3. Direction: Is there a clear rationale, progress measure, and adjustment plan?

If the answer to any of these is no, the concern deserves action—not silent endurance.

Safety note

This article is educational and does not diagnose or replace individualized medical or mental-health care. Do not stop prescribed medication or abruptly end high-risk treatment without discussing safety and continuity with a qualified clinician.

Sources

1. National Institute of Mental Health. Psychotherapies
2. American Psychological Association. Understanding Psychotherapy and How It Works
3. National Center for Complementary and Integrative Health. Health Topics A–Z
4. 988 Suicide & Crisis Lifeline. Get Help