Shouldn’t psychotherapy make me feel good?

It's the end of our third session and Jane gets up and walks to the door. After the customary "see you next week," Jane adds:

"Thank you so much for these sessions. I really feel a lot better afterward."

Uh oh.

A common misunderstanding about therapy is that its function is to help us "feel better" each week. Many equate psychotherapy with the day spa where we enter with tension and leave feeling relaxed and refreshed. Sometimes this is the case. But much of the time we leave with a greater understanding of the gravity, severity and prevalence of our issues. We think we have one problem but realize we have five. This doesn't always feel better; it can feel much worse.

That's why my response to Jane's comment is "uh oh." If she's expecting to always feel good after her sessions, she may be setting herself up for disappointment.

In the first few sessions the therapist and client are getting to know one another and explore the issues. If there's a good connection between them, clients often feel relieved, supported and hopeful. The issue they've held inside is finally being addressed, the therapist seems to care and understand without judgment, and there's a real sense that progress can be made. This feels good.

As the work continues, things often get worse before they get better. In his book The Heart of Psychotherapy, psychologist George Weinberg writes:

"In the course of psychotherapy, we help the person see the generality of his problem...As patients see, 'This problem is more pervasive than I thought,' they are occasionally disheartened somewhat...And to the extent that the problem was broader than they thought, the gain is greater when it is resolved." (p. 18)

Jane entered therapy to better understand her difficulty with dating. She describes herself as a "serial monogamist" who dates men until her suspicions lead her to believe he is untrustworthy. In these first three sessions, she's been able to tell her story, vent a bit about her lousy relationships, and feel that I am working to understand and assist her. She truly feels better after the session because she was heard and supported. But our future sessions may go into uncomfortable territory. We might discover that her suspicions have cost her many friendships as well. We could find that painful events in her childhood made trust very difficult to maintain. We might even find that her issues extend to herself - that she has a hard time trusting her own thoughts and feelings, and she projects this onto other people. These harsh realizations won't leave her with a spring in her step. This is the "disheartened" feeling Weinberg mentions.

I've seen many clients get to this point in therapy and decide to stop. We've opened several cans of worms and they simply feel overwhelmed. I don't blame them for feeling this way, but encourage them to stick with it. This is the pain we endure to achieve the gain. I equate this process with a person organizing a long-forgotten basement or closet - when you start pulling stuff out it's easy to feel overwhelmed by the clutter and sheer volume of material. Leave it now, and you're stuck with a big mess on your hands. But push through and you'll see gradual progress and eventually a more organized space.

I believe the goal of psychotherapy is to help each client grow in awareness, understanding, responsibility and acceptance. Rather than helping her "feel better" an hour a week, I hope therapy helps Jane know who she is, why she does what she does and feels how she feels. I hope it helps her realistically appraise her strengths and limitations, giving her the freedom to choose relationships, jobs and activities that bring her joy, accomplishment and contentment.

So in the end, I also hope therapy helps Jane feel a lot better. But I recognize we have some hard work to do before we get there.