Facing Challenges in Therapy: Why It's Hard and How to Navigate It

I've seen how therapy can be a safe space for clients to be vulnerable and explore difficult parts of their childhood, but also how challenging that can be at the same time.

Therapy often involves exploring painful emotions or experiences that you may have suppressed. This is an important part of therapy, but it is never easy or comfortable to work on things you have been avoiding for years.

The experience of therapy can also feel challenging. You can feel emotionally overwhelmed, resistant, avoidant of certain topics, or notice a lack of progress.

Table of Contents | Jump Ahead

• Emotionally Overwhelming
• Resistance and Avoidance
• Feeling Stuck or Making No Progress
• Self-Compassion Practices
• Effective Coping Strategies
• Stay Curious Rather Than Self-Critical
• Focus on Small Steps
• When Challenges Become Concerning
• References

Emotionally Overwhelming

From time to time, therapy sessions can trigger intense emotions. You might leave sessions feeling emotionally drained or more upset than when you arrived.

What this looks like:

• Feeling flooded with emotions during or after sessions
• Difficulty functioning normally after therapy appointments
• Wanting to avoid sessions because they feel too intense
• Physical symptoms like headaches, fatigue, or sleep disturbances

Why it happens:

Noticing and becoming aware of suppressed emotions or memories from the past, can feel emotionally overwhelming. Perhaps this is the first time you’re acknowledging something painful and noticing how tender it is.

Resistance and Avoidance

You might find yourself resisting your therapist's suggestions, avoiding certain topics, or wanting to quit therapy altogether.

What resistance and avoidance look like:

• Consistently arriving late or missing sessions
• Changing the subject when difficult topics arise
• Feeling angry or defensive toward your therapist
• Wanting to constantly find solutions rather than feel your emotions
• Wanting to quit therapy when progress feels slow

Why it happens:

Resistance often occurs when therapy approaches core issues that feel threatening to explore. It is the mind's way of protecting you, even when that protection is no longer needed.

Feeling Stuck or Making No Progress

There may be periods when therapy feels stagnant, like you're covering the same ground repeatedly without making meaningful progress. This can be particularly frustrating when you're investing time, energy, and money in the process.

What this looks like:

• Feeling like you're repeating the same conversations
• No noticeable improvement in symptoms or functioning
• Feeling like your therapist doesn't understand you
• Comparing your progress to others or to your expectations

Why it happens:

Even when progress seems stalled, your brain may be processing important changes beneath the surface (Kleiven et al., 2020).

Note though: There are various methods to help you face these challenges. These challenges are not obstacles to your healing journey, but rather the pathway to it. It represents opportunities for growth, learning and deeper healing.

• It is important to see these challenges as a normal part of the healing process.
• Resistance or avoidance should be rather viewed as a sign of engagement in your own healing process.
• Remember that the discomfort might precede breakthroughs.
• Self-compassion is an integral part of helping you through this.

Self-Compassion Practice can include:

• Acknowledging that therapy is hard work and you're being brave
• Avoid self-criticism for having difficulties or making slow progress
• Practice self-care between sessions to support your emotional well-being
• Remember that healing takes time and isn't always linear

Develop and use healthy coping strategies to manage difficult emotions that arise between therapy sessions. This can help you feel more stable and better able to engage with the therapeutic process.

Effective coping strategies:

• Physical exercise or movement
• Connecting with supportive people
• Creative or meaningful activities
• Grounding techniques

Stay curious rather than self-critical of your process

When you encounter resistance or difficult emotions, try to approach them with curiosity rather than judgment. Ask yourself what these feelings might be trying to tell you or protect you from.

Curiosity questions to ask yourself:

• "What is this resistance trying to protect me from?"
• "What would happen if I allowed myself to feel this emotion fully?"
• "What does this difficulty remind me of from my past?"

Focus on Small Steps

When therapy feels overwhelming, break down your goals into smaller, more manageable steps. Celebrate small victories and progress, even when the overall journey feels difficult.

Small step examples:

• Attending sessions consistently, even when you don't want to
• Sharing one difficult emotion or experience per sessio
• Practising one new coping skill between sessions
• Asking for clarification when you don't understand something

When Challenges Become Concerning

While most therapy challenges are normal and workable, there are some situations that may require additional attention or intervention:

• Persistent Worsening of Symptoms: If your symptoms consistently worsen over several weeks without any periods of improvement, this may indicate that the current approach isn't working for you or that you need additional support.
• Feeling Unsafe or Unsupported: If you consistently feel judged, criticised, or unsafe with your therapist, this may indicate a poor therapeutic fit or boundary violations that need to be addressed.
• Thoughts of Self-Harm: If therapy triggers thoughts of self-harm or suicide, it's crucial to communicate this immediately to your therapist and seek additional support if needed.
• Inability to Function: If therapy consistently leaves you unable to function in your daily life for extended periods, you may need to adjust the pace or approach of your treatment.

Remember that you don't have to navigate these challenges alone. Your therapist is there to support you and help you develop the skills to handle difficult periods effectively. By staying committed to the process, communicating openly, and practising self-compassion, you can work through even the most challenging periods in therapy.

The courage you show in facing these difficulties is the same courage that will serve you throughout your life. Each challenge you work through in therapy builds your capacity to handle whatever life brings your way. Trust in the process, be patient with yourself, and remember that the most meaningful growth often comes from the most challenging experiences.

References

Eubanks, C. F., Burckell, L. A., & Goldfried, M. R. (2018). Clinical consensus strategies to repair ruptures in the therapeutic alliance. Journal of Psychotherapy Integration, 28(1), 60--76. https://doi.org/10.1037/int0000097

Kleiven, G. S., Hjeltnes, A., Råbu, M., & Moltu, C. (2020). Opening up: Clients' inner struggles in the initial phase of therapy. Frontiers in Psychology, 11, 591146. https://doi.org/10.3389/fpsyg.2020.59114

Linehan, M. M. (2015). DBT skills training manual (2nd ed.). Guilford Press.

Neff, K. D., & Germer, C. K. (2013). Mindful self-compassion. Journal of Clinical Psychology, 69(1), 28--44. https://doi.org/10.1002/jclp.21923

Safran, J. D., Muran, J. C., Samstag, L. W., & Stevens, C. (2001). Repairing alliance ruptures. Psychotherapy, 38(4), 406--412. https://doi.org/10.1037/0033-3204.38.4.406

Strupp, H. H. (1980). Success and failure in time-limited psychotherapy. Archives of General Psychiatry, 37(8), 947--954. https://doi.org/10.1001/archpsyc.1980.01780200099011

Waller, G. (2009). Evidence-based treatment and therapist drift. Behaviour Research and Therapy, 47(2), 119--127. https://doi.org/10.1016/j.brat.2008.10.018