Feeling Worse in Therapy? Why That Might Be Progress

Your therapist said you’re making progress, but you feel more anxious than when you started. Your panic attacks are more frequent. You’re having trouble sleeping. You’re wondering if therapy is actually making things worse. Here’s something nobody warns you about: sometimes getting better means feeling worse first. This guide explains why temporary worsening is often the clearest sign that you’re breaking through your defenses and doing the real work of healing.

Let me tell you something most therapists don’t say explicitly enough: if therapy never makes you uncomfortable, you’re probably not doing deep work. Real change requires confronting the very thoughts and situations your brain has spent years helping you avoid.

Maybe you’ve been in therapy for three weeks and your anxiety feels worse than before you started. Maybe you’re having more panic attacks, not fewer. Maybe you’re questioning whether your therapist knows what they’re doing, or whether you should quit before things get even worse.

This is the moment where many people drop out of treatment, right before the breakthrough. This guide explains what’s actually happening when therapy gets harder, how to distinguish normal therapeutic discomfort from genuinely concerning symptoms, and why persisting through this phase is often the difference between lasting change and returning to old patterns. If you need support navigating treatment decisions, you can access your patient portal for resources between sessions.

Why Therapy Sometimes Gets Harder First

Think of anxiety like a smoke alarm that’s become hypersensitive. For years, you’ve managed this overactive alarm by avoiding anything that might trigger it. You don’t go to crowded places. You decline social invitations. You arrange your entire life to minimize the alarm going off.

Then you start therapy, and your therapist asks you to deliberately set off that alarm. Not randomly, but systematically and with support. This is exposure therapy, and by definition, it means experiencing anxiety as you face situations you’ve been avoiding.

The initial increase in symptoms isn’t a sign that treatment isn’t working. It’s evidence that meaningful change is beginning to take place. You’re learning to do the opposite of what anxiety tells you to do. Instead of avoiding feared situations, you’re facing them. Instead of seeking reassurance, you’re learning to tolerate uncertainty.

The Role of Avoidance in Maintaining Anxiety

Avoidance is one of the most powerful mechanisms that keeps anxiety disorders alive. Every time you avoid something that makes you anxious, your brain learns “that situation is dangerous, and avoiding it kept me safe.” This reinforces the fear, making it stronger for next time.

When therapy begins systematically breaking down these avoidance patterns, your anxiety alarm system naturally responds by ringing louder. Your brain is essentially saying “why are we doing this dangerous thing we’ve always avoided?” This response is protective in nature, even when it feels overwhelming.

Uncovering Defensive Mechanisms

Beyond avoidance, your psyche has developed sophisticated defensive mechanisms over years or decades. These defenses serve a purpose: they protect you from feelings or memories that once felt too overwhelming to process. Common defenses include denial (refusing to acknowledge painful realities), repression (blocking distressing memories from awareness), rationalization (justifying behaviors to avoid true emotions), and displacement (redirecting negative emotions toward a less threatening target).

When therapy begins identifying and gently challenging these defenses, it can feel destabilizing. You might experience more intense emotions than usual because you’re no longer unconsciously blocking them. You might feel more vulnerable because the protective barriers are coming down.

Why Defenses Resist Change

Your defenses don’t want to be dismantled because from their perspective, they’ve been keeping you safe. When therapy challenges these patterns, internal conflict arises. Part of you wants to change and heal, while another part resists anything that feels threatening to your established sense of self.

This internal tension often manifests as increased anxiety, emotional reactivity, or even physical symptoms like headaches or fatigue. These aren’t signs of therapy going wrong. They’re signs that you’re touching something real and important that your mind has worked hard to keep buried.

Working Through Resistance

Resistance in therapy doesn’t always look like refusing to attend sessions or arguing with your therapist. Often it’s subtle: forgetting to do homework assignments, arriving late, intellectualizing instead of feeling, or suddenly having “nothing to talk about” after weeks of productive sessions.

This resistance isn’t willful or bad. It’s your mind’s way of applying the brakes when therapy starts moving toward material that feels threatening. The resistance itself provides valuable information about where the most important work needs to happen.

How Therapists Work With Resistance

Skilled therapists don’t fight against resistance. They explore it with curiosity. Why might this particular topic feel threatening? What’s the fear underneath the avoidance? What would it mean if you fully engaged with this material?

When resistance is addressed directly and compassionately, it often begins to soften. But during the process of working through resistance, you may experience increased anxiety, irritability, or emotional overwhelm. These symptoms typically indicate that you’re getting closer to important material, not that treatment is failing.

When Facing Fears Increases Anxiety

Exposure therapy is one of the most evidence-based treatments for anxiety disorders, but it works precisely because it temporarily increases anxiety. If you have social anxiety and your therapist asks you to give a presentation, you will feel anxious. If you have panic disorder and you engage in exercises that trigger physical sensations, you will feel uncomfortable.

The goal isn’t to avoid anxiety. The goal is to learn that you can tolerate anxiety, that it peaks and then decreases, and that the catastrophic outcomes you fear don’t actually happen.

The Timeline of Exposure-Related Anxiety

Most people experience the highest anxiety during the first few exposure exercises. Your brain doesn’t yet have evidence that facing these situations is safe. By the fourth or fifth exposure, anxiety typically starts decreasing because your brain is beginning to learn a new pattern.

However, if you quit after the second or third exposure because “it’s making me worse,” you never get to the phase where the anxiety curve turns downward. This is why persistence through temporary discomfort is essential for long-term improvement.

Seven Signs Your Discomfort Means Breakthrough

How do you know if your increased discomfort is actually a positive sign? Here are indicators that temporary worsening represents progress rather than harm:

1. The anxiety is specifically related to therapy homework or exposure exercises. If your panic attacks happen right after doing an exposure assignment, that’s different from panic attacks appearing randomly with no connection to treatment work.

2. You’re becoming more aware of patterns you couldn’t see before. Increased awareness can make anxiety feel more prominent, even when the actual frequency hasn’t increased. It’s like turning on a light in a cluttered room and suddenly seeing all the mess that was always there.

3. You’re feeling emotions you’ve been avoiding for years. Sadness, anger, or grief surfacing in therapy often means you’re finally processing feelings that were suppressed by anxiety and avoidance.

4. Your therapist predicted this would happen. If your therapist explained that symptoms might temporarily increase as you begin facing fears, and that’s exactly what’s happening, you’re likely right on track.

5. You feel uncomfortable but not unsafe in sessions. There’s a difference between the discomfort of growth and feeling genuinely threatened or retraumatized. Growth discomfort is challenging but ultimately feels like you’re working toward something important.

6. Despite feeling worse, you sense something is shifting. Many people describe a feeling of “productive struggle” where the discomfort comes with an underlying sense that real change is beginning to happen.

7. The difficult sessions are followed by moments of clarity or relief. Breakthroughs often come in waves. A particularly hard session might be followed by new insights or a sense of release.

Normal Worsening vs. Concerning Symptoms

While temporary increases in anxiety are common and expected, certain symptoms warrant immediate attention and discussion with your therapist. Understanding this distinction is crucial for your safety and treatment success.

Normal Temporary Increases Include:

Heightened anxiety specifically related to exposure exercises or therapy homework, increased awareness of anxiety symptoms that were previously ignored, temporary spikes in anxiety following challenging therapy sessions, mild increases in general anxiety as you face previously avoided situations, and sleep disruption or concentration difficulties during the first few weeks.

Concerning Symptoms That Need Immediate Attention:

Severe panic attacks that don’t respond to coping skills you’ve learned, thoughts of self-harm or suicide, complete inability to function in daily activities like work or basic self-care, symptoms that continue worsening after the first month rather than beginning to plateau, or development of new symptoms unrelated to treatment exercises.

One key distinction: normal worsening is temporary and specific to the work you’re doing in therapy. Concerning worsening is persistent, severe, and interferes with your basic functioning. If you’re unsure which category your symptoms fall into, err on the side of caution and discuss it with your therapist.

How to Stay the Course During Difficult Sessions

Knowing that discomfort can be part of progress doesn’t make it easier to tolerate. Here are practical strategies for persisting through challenging phases of therapy:

Communicate openly with your therapist. Tell them you’re struggling. Ask them to explain what’s happening and whether your experience fits with their treatment plan. Good therapists expect and welcome these conversations.

Set concrete goals and revisit them regularly. When you’re in the middle of difficult work, it’s easy to forget why you started therapy. Written goals remind you of what you’re working toward and why the temporary discomfort is worth it.

Use between-session support. Many therapists offer brief check-ins between sessions when clients are going through particularly difficult phases. Ask what support options are available.

Practice self-compassion. Therapy is hard work. You’re confronting things most people spend their lives avoiding. That takes courage, not weakness.

Trust the process, but verify it’s the right process. Temporary worsening can be normal, but if your gut tells you something is genuinely wrong with how therapy is being conducted, listen to that. You can seek a second opinion or discuss concerns with another mental health professional.

Written By

Cara J. Erkut, M.D.

Board-Certified Psychiatrist | Psychoanalyst | Clinical Instructor, University of Washington

Dr. Erkut is a board-certified psychiatrist and psychoanalyst with extensive training in psychodynamic therapy, anxiety treatment, and the intersection of medication management with psychotherapy. She completed her medical degree at Mayo Medical School and her psychiatry residency at the University of Washington, where she served as Chief Resident and founded the Advanced Psychotherapy Studies track. She later completed full psychoanalytic training at the Seattle Psychoanalytic Society & Institute, giving her deep expertise in understanding therapeutic process and working through resistance. As a Clinical Instructor at UW, she teaches advanced psychotherapy techniques to the next generation of psychiatrists.

Connect on LinkedIn