It gets worse before it gets better

There is a common paradox for psychological therapy: many times the strategies we have found to provide us relief from our problems are at the same time perpetuating our problems. For example, a man suffering depression may find that staying in bed all day is the only way to get some slight relief from his persistent sadness and guilt. Yet, at the same time, staying in bed is keeping him isolated from social supports that could play an important part in his recovery. It is also feeding back into his guilt when, at the end of the day, he reflects on all the things he “should” have done instead of being in bed.

A woman with a phobia of mice may find running and hiding in another room if she sees a mouse gives her relief from her feelings of terror – yet in doing so she has unintentionally reinforces her automatic fear response to seeing mice.

Therapy generally involves, at some point, changing unhelpful patterns in one way or another. Initially this means stopping use of strategies that have had at least short-term benefits. Consequently, therapy can at times be very uncomfortable: you make a choice to confront difficult feelings and experiences that you have developed a range of strategies for avoiding. Because of this I often caution clients that “it gets worse before it gets better.” It is often necenssary to sit through discomfort, sometimes considerable discomfort, to experience the reward of mastering a problem.

This naturally raises the question: “Is it worth it?”

Seeing a psychologist is much like receiving any other treatment: It comes at a cost. Sometimes, depending on the circumstances, the cost of a treatment may not be worth the payoff. People sometimes choose not to have a surgery because the risks or side-effects are, for them, a greater cost than the problem the surgery would fix. For a person with a phobia of hypodermic needles who is in good health, the discomfort of treatment of that phobia may have no associated benefits. But if a medical condition develops that requires blood tests or IV treatment, the value of therapy may then outweigh the discomfort it would involve.

Before considering therapy, it is worth examining the costs and the benefits. How does the problem for which you are considering therapy affect your life? How does it affect those you care about? How would your life be different if you didn’t have this problem? How challenging might it be to change?

In weighing the costs and benefits, however, there is one thing to keep in mind: We often overestimate how difficult a challenge will be and we often underestimate our own capacity for coping. In fact, both of these tendencies play an important part in why problems exist in the first place: I run away from the mouse because I overestimate how terrifying it would be to stay put, and I underestimate my capacity to cope with those feelings.

There is a final worthwhile consideration: When change occurs in therapy it is by no great accomplishment of the psychologist, but rather the triumph of the client. How would it feel to know with certainty that you can overcome – because you are looking back, having done it?

About Paul McQueen

Dr Paul McQueen is a Clinical Psychologist, holding a Doctorate in Clinical Psychology from the University of Melbourne. He has experience working in both adult and child mental health services in Queensland and Victoria. Dr McQueen is comitted to providing high quality, evidence-based interventions for a range of mental health conditions. He specialises in the treatment of Obsessive Compulsive Disorder, Borderline Personality Disorder and Depression.

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