How to Manage Therapy Side Effects
Sometimes healing hurts
Caring for yourself in-between therapy appointments is essential for treatment success. It is not uncommon to notice various changes in your mood, affect or behavior following a session. This does not mean that therapy is going awry, but just like any healing remedy in life, there can be side effects. Knowing these side effects can help you be prepared and arrange a proper self-care regimen
The Therapy Side Effects range from mild to remarkable and can include:
Sadness
Inappropriate guilt
Anger (especially if you don’t typically feel anger)
Fatigue/tiredness
Appetite changes
Weird dreams or nightmares
Aches and pain that can’t be explained medically
Irritability
Racing thoughts/intrusive thoughts
Grief
Numbing out
Feeling flooded
Feeling withdrawn/isolating
Increased self-medicating
Relapse into addiction
Self-harm attempts
Increased suicidality
Urge to quit therapy, showing up late for appointments or late-cancelling (some will actually quit)
Feeling more clingy to therapist
Confusion/inattentiveness
Weakened immune system due to high stress
Psychosomatic health complaints: getting sick around session days and cancelling the sessions
Increased interpersonal conflict
Why do these various reactions get kicked up? What is it about therapy that activates these effects?
Perhaps it is because in therapy…
you reckoned with the fact that you are the first person in your generation or in your family of origin to seek therapy or you are the only person involved in an interpersonal conflict that is seeking help—and that feels hard!
the therapeutic relationship is ethical and healthy and this feels weird because you are not used to safe, boundaried, compassionate relationships.
you faced the reality of how your needs were insufficiently met or missed as a child.
you finally admitted you actually do suffer from depression (or any other condition you’ve been hesitant to name).
you learned about trauma and realized you are a trauma survivor.
we met some of your hidden parts for the first time, which often includes parts of you that you don’t like.
we unearthed a reality about your story that you had suppressed.
you remembered something traumatic that you had repressed.
we identified a faulty belief, narrative, perspective or a lie that you’ve been living by and you now have to confront it.
you took your armor off and allowed yourself to be raw and vulnerable with another person and now you feel exposed and uncomfortable.
the therapist confronted or challenged you in a way that felt upsetting.
the therapist invited you to swap out an unhelpful mechanism for something more helpful and you feel reluctant to make the change.
you learned a new skill that is disruptive to your current cycles and patterns.
you were asked to do a difficult homework assignment.
you are aware that you really don’t like therapy, but you need it.
Giving up unhelpful ways of feeling, thinking and behaving can bring you to a point of crisis. When you return to your life as you know it, you now have the choice to respond in a new way or the old way. You will feel the inner tension building when you have the new tool or skill at your disposal, but still feel pulled to behave from your fragmented self. And because you don’t like this tension, you will be tempted to return to therapy the next session, downplay your symptoms, present yourself in an overly idealistic light, avoid “going there” again, respond with defenses when the therapist challenges you or transfer your tension onto the therapist. This is all normal.
But a better way forward is to keep a log of your ‘between-session’ side effects and talk to your therapist about them. For example, if you feel irritable because in the last session the therapist confronted a faulty belief, bring this up—instead of acting out your irritability toward the therapist. If you are avoiding therapy (as evidenced by “repeatedly forgetting to log on for your session”) because you allowed yourself to be too vulnerable in the last session, speak to your therapist about this openly. Your therapist can discuss a plan of action with you to help you tolerate these experiences better.
Here is my ETA NAMING Tool to use to manage therapy side effects:
Name the EFFECT you are experiencing after your session (is it a feeling, a thought, belief, body sensation, physiological change, an urge, etc?)
Name the TENSION you are experiencing due to the new skills you are learning (i.e. “I know I shouldn’t be in this relationship any longer, but I can’t cut it off” or “I learned skills to stay in my adult self, but I feel a strong urge to shut down right now”).
Name the ADJUSTMENTS you need to make in order to relieve the tension and care for your needs (i.e. I will do one hard thing today, I will practice my deep breathing skills, I will check in with my inner child daily, I need to go to bed on time etc).
Remember, therapy side effects are normal and can be useful parts of the therapy process. But when they are improperly interpreted and handled, they can actually thwart the effectiveness of treatment and block access to adaptive resolution of whatever you are targeting in therapy.
**For those who are Born Again and have a relationship with Christ, therapy side effects could be: prompts for you to confront areas of weakness in your life, invitations to practice obedience, or evidence of where God is working in your healing journey.
Shalom
