When therapy is uncomfortable, is it because it's working?

August 26, 2020 11:30 AM

... Or is it just uncomfortable because it's a bad fit? How do you tell?
posted by Cozybee to Health & Fitness (12 answers total)

It can be hard to tell, especially if you haven't had too many therapists. Some discomfort is to be expected and can be good in the long run; some can be because the therapist just isn't reading you right and is pushing you in ways that aren't productive.

Can you explain any more about how therapy feels uncomfortable?
posted by showbiz_liz at 11:34 AM on August 26, 2020 [1 favorite]

Its hard to tell sometimes, and sometimes depends on why you're in therapy in the first place. If you have a trauma-rooted-diagnosis, you may be uncomfortable with certain therapy techniques and if you had a MDD diagnosis, you might be comfortable with those same techniques.

Having meta conversations in therapy about therapy is totally acceptable and should be encouraged. Educating yourself about modalities and how they work, even on a cursory level, is valuable. Being able to talk to your therapist about what is helping, what isn't, and what you aren't sure about is a great practice to engage in. This is a great question for your therapist, and how they handle that conversation can be an enlightening exchange on if that therapist is a good match or not.
posted by furnace.heart at 11:44 AM on August 26, 2020

My goodness, I wanted to pose that question, albeit with more details. I'll echo this, can you narrow down what feels uncomfortable?
posted by Omnomnom at 11:52 AM on August 26, 2020

I wonder if it's useful to compare to massage therapy. A massage can be intense - even painful! But the goal is that you feel better afterwards. You can also tell your massage therapist, "Ow, that hurts too much," and he/she should dial it down. The same is true for psychotherapy.
posted by boghead at 12:01 PM on August 26, 2020 [10 favorites]

I'll add that I've gotten great mileage out of saying to my therapist "I hate it when you do X. It makes me feel Y." And then we get to explore where the discomfort is coming from and treat it as something productive. Maybe that might help you?

I take a sort of savage joy in throwing all those emotional reactions at my therapist that I'm too timid to say to people in my normal life, and know that that's welcome and useful. (I'm probably the only one who was really excited about transference happening so I could do something productive with it.)

But there are things she does where I don't seem to be getting anywhere with this feedback, like the way I'm never sure if we're actually going somewhere or just drifting from topic to topic, or the way she often doesn't understand what I'm getting at (am I bad at expressing myself, and have too high expectations to boot, or is she just not that good at listening, which, surely, is one of the main requirements??).
posted by Omnomnom at 12:07 PM on August 26, 2020 [4 favorites]

It's impossible to say without any more detail. A lot of reputable therapeutic tactics (e.g., CBT) are intended to make you uncomfortable. But there are obviously plenty of other reasons you could be uncomfortable. How to tell? Does it feel like whatever you're treating is improving? Obviously whatever you're dealing with isn't going to be cured in one session, but if you look back at the person you were a few months ago, do you feel different?
posted by kevinbelt at 12:30 PM on August 26, 2020

Also hard to say without more detail, but absolutely yes, therapy can be uncomfortable. And facing that discomfort, working through it, processing it is a really valuable part of therapy--even if at the end, you decide that the therapist not the right fit. There is so much value in that; and how you apply that experience with handling, tolerating, being curious about discomfort will reap you benefits both in therapy, but more importantly, out in the real world.
posted by namemeansgazelle at 1:00 PM on August 26, 2020

I wonder if it's useful to compare to massage therapy.

I also wonder if it's useful to compare to education, in one of my former lives, I was a program director for a 9 month certificate program. This program had a policy of issuing teacher evaluations that the students filled out at the end of each week. There were a few teachers who I personally knew were excellent but they really challenged students, and like clockwork, they would often get terrible reviews at the beginning of the semester, but 3 months later they were almost universally loved.

My point here is it's hard to evaluate what "uncomfortable" is, when that is sometimes the point. I'm not a therapist, but my wife is, so I get a lot of insight into the patient-therapist relationship by proxy. One thing I can say is that any therapist worth their salt will typically welcome a patient bringing this up (preferably at the beginning of a session) and should be willing to talk through it without becoming defensive or trying to steer the conversation back to "you".
posted by jeremias at 1:29 PM on August 26, 2020

Signs that it's uncomfortable because it's a bad fit: you don't feel heard; you don't feel understood; you feel like the therapist is trying to impose their own narrative on you. That's not to say they should always take you at your word, but... they should always take your word seriously. If you feel scared to be honest, that's something to look at closely. Are you scared because it's scary to tell emotional personal stuff to other people? Because you've been taught not to trust other people with emotional personal stuff? Or is there something about this therapist that feels unsafe?

If you feel like you're being pushed too hard or too fast, you always have the right to say "I don't feel comfortable talking about that yet," and good therapists will take that seriously - not that they won't push you on it, but hopefully they'll push you on it in ways that are productive and show a certain level of trust in your own ability to make decisions about what you can talk about.
posted by Jeanne at 2:01 PM on August 26, 2020 [2 favorites]

I think it depends. I've had both! When it was super painful but working, I had trust in my therapist and also sometimes discussed my discomfort with her; the first year sucked and the second year was much better, even pleasant at time. I don't know what modality you're using but I was doing trauma work with EMDR. In fact, I added an SSRI to the mix about half way through to help ease the stress of processing past traumas and working through some current hard stuff. Therapy was definitely worth it but it wasn't fun, and it took me about five tries to find a good match. The first was super judgmental, the second was good in some ways but didn't really understand me, and the third was all sorts of batshit crazy; I saw the fourth for a year and she helped me get to a good place where I'd be open for the deep shit, which is when I switched once again and found an ideal match.

Do you like and respect your therapist? Do you think they're smart and insightful? Do you think they "get" you, not necessarily completely but understand where you're coming from?
posted by smorgasbord at 4:28 PM on August 26, 2020 [1 favorite]

The idea that if therapy hurts it’s working is a horrible myth that removes accountability from therapists. Discomfort from therapy should be transient, mild, and related to why you’re in therapy. If you’re not feeling better it’s not working.
posted by Violet Hour at 9:15 PM on August 26, 2020 [2 favorites]

In my experience, the "good" kind of discomfort is always followed by catharsis — it doesn't go on and on and on forever.

Talking through things makes you uncomfortable in therapy because the mind throws up a lot of emotional barriers to make you avoid your problems. But after you and the therapist work through it, there should be a feeling of ease, of being understood, and of unburdening. Kind of like the relief of a good cry. Perhaps also a sense that you have solved a problem, or understood something new about yourself.

If the discomfort goes on & on without ever easing up, I would take that as a signal that this therapist is a bad fit. There is a definite difference between a) feeling resistance to a good, healthy idea because your mentally ill brain is self-sabotaging, and b) having a therapist try to impose their own narrative without really understanding you.

On a different note: it's possible to find a therapist with a different approach, maybe one who can help you make progress in a less invasive way, without constantly feeling uncomfortable. I think it's perfectly legitimate to prefer this kind of therapy and seek it out — be gentle with yourself!
posted by fire, water, earth, air at 12:53 AM on August 27, 2020