What to Do When Therapy Gets Hard
So you've started therapy, and it's actually going pretty well. Maybe you've been going for just a couple of months or a few years. You're working well with your therapist feel you're making good progress. The counseling seems to be helping. Things are humming along.
Then, whether gradually over time or all of the sudden, there's a shift.
Life gets really hard. Almost unbearable. And so does therapy. Wait a minute. Weren't things supposed to get better? Why now is the terde hitting the ventilateur?
It's important to understand that I'm speaking in generalities here, and painting with broad strokes. But often there's a really good reason why therapy gets hard. It means you're doing the work. Here's what I mean.
The Basic Fault
One way to think about what happens when therapy gets hard that I've found useful comes from British psychoanalyst Michael Balint's book The Basic Fault (1968). The title comes from his idea that many of us, and many clients in counseling, come to feel during therapy that there is a fault within them, that there's something wrong with them that they can't set right. He describes the basic fault this way:
The patient says that he feels there is a fault within him [or her], a fault that must be put right. And it is felt to be a fault, not a complex, not a conflict, not a situation. Second, there is a feeling that the cause of this fault is that someone has either failed the patient or defaulted on him; and third, a great anxiety invariably surrounds this area, usually expressed as a desperate demand that this time the analyst [therapist] should not—in fact must not—fail him (p. 21).
The "great anxiety" often occurs because the therapy is helping the client to get to deeper, more vulnerable parts of the self that have previously been hidden or out of awareness. Often, these more vulnerable parts of ourselves are holding longstanding pain from wounds we've experienced when we were very young. When we feel these states, they can feel raw, out of control, and overwhelming. As they represent younger parts of ourselves, we may revert to more childlike ways of dealing with these feelings—yelling, blaming, crying, raging, rocking, repeating words to soothe ourselves, etc. Therapists call these ways of being regressive states, and the process of returning to these behaviors regression.
Before You Fire Your Therapist, Read This
If you're doing depth-oriented therapy that's helping you deal with your childhood shit, regression is inevitable. It's going to happen. Good therapy will necessarily involve regression. More than that, it's not a sign that things are getting worse. They're getting better. We need to access our wounds and feel the pain they cause with an understanding, accepting other for healing to happen.
How to Know You Might Be at Your Basic Fault
If and when therapy gets hard, it doesn't necessarily mean that you're regressing to your basic fault. Though your experience is unique to you and you should always discuss your thoughts and feelings with your therapist, here are a few signs straight from Balint that you may be nearing your basic fault:
What your therapist is doing or saying isn't working for you anymore, in fact, it might be pissing you off or making you feel more anxious or depressed.
You feel more lifeless and hopeless than ever.
You notice that you're more sensitive to what your therapist is doing, how she feels, or what she says.
You don't feel like yourself and you're certainly not acting like it.
You may be struggling with addictive behaviors more than you have in the past.
What to Do When Therapy Gets Hard
If you feel lost and overwhelmed as you near your basic fault, it's important to remember to hang in there. What you're going through now certainly feels like the darkness will never lift, but it will. Stay with it. If you trust your therapist, trust the process. It's going to get better. Here are a few other things you might do with your therapist when the going gets rough:
Ask your therapist for more support by check-ins between sessions or more frequent sessions
Seek out a support group
Talk to your therapist about your feelings about her (yes, even when you're pissed off)
Ask your therapist to teach you some tools to manage difficult feelings
Share any journal entries or dreams with your therapist
Be patient with yourself and with each other
This is just a partial list, of course, and there's much more to say about how and why this can happen in counseling—how it must happen for real change to occur. If you want to read more about it, drop me a line. I'd love to hear from you.
About the Author
Jeremy Mast is a licensed marriage and family therapist, a Certified Sex Addiction Therapist, and the founder and director of the Center for Integrative Change. He is passionate about helping those struggling with substance use and problematic sexual behaviors and their loved ones find lasting healing. In his spare time, he enjoys reading, rock climbing, health and fitness, and trying out new recipes while cooking at home.