I recently read a post on a mental health blog which said “Talking therapy is great, but things get worse before they get better, so you have to stick with it.”
This is a misguided generalisation that can do harm be preventing people from seeking therapy. It might also be an excuse an ineffective therapist could use.
Therapy is about growth and positive change. In my case – and like other brief therapists – I expect each session to make a difference. Clients should feel better at the end of a session than they did at the beginning.
This doesn’t mean the problem is ‘fixed’, but they should feel more optimistic and hopeful about whatever brought them to therapy than they did when they made the appointment. If one of my clients feels worse at the end of the session, then it is not the end of the session. It is my responsibility to ensure that they leave each session feeling empowered and able, even when they are involved in longer-term therapy (not everyone chooses single-session).
Expectation is self-fertilising; positive expectation tends to promote positive outcomes, and negative expectations do the opposite. Telling someone to expect that they’ll feel worse might be an appropriate preparation if there is good reason to say it (when the pain killers wear off for example). And it is certainly true that even when people are well on the road to recovery from, say depression or loss, they can still have a bad day. But the trend should always be improvement.
True, when you start in therapy, you might feel a little discomfort, the sort that goes with trying anything new. Creating and expectation of negative change (or feeling worse) before you get better is not only misguided, it is irresponsible and just plain wrong.