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.

If one of my clients feels worse at the end of the session, then it is not the end of the session.

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.

A hopeful outlook

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). But it is counter-therapeutic and ill-advised to deliberately set up an expectation that “things will get worse before they get better”.

Reframing setback

While it is certainly true that even when people are well on the road to recovery from, say depression or loss, some can still have a bad day. At the time, against the background of general improvement, a small step back like this can seem like a disappointing setback. But predicting it only increases the likelihood that the client will notice the bad days and no wise therapist should go down that route.

Whatever the inevitable ups-and-downs on the road to healing and recovery, the focus should always be towards improvement. Acknowledging and normalising bad days when they happen is OK, predicting them is not.

True, when you start in therapy, you might feel a little discomfort, the sort that goes with trying anything new. Creating an expectation of negative change (or feeling worse) before you get better is not only misguided, it is irresponsible and just plain wrong.