Feeling Worse After EMDR Therapy? It Might Mean It's Working

“You might feel worse before you feel better”. It sounds like a disclaimer, a therapist butt-covering exercise if you will. I used to think so too. 

But after many years of doing trauma and EMDR therapy, I have learned that you can absolutely feel worse before you feel better. It is legit, but it does deserve some attention, because feeling worse and getting worse are not the same thing.

That distinction changes everything about how you interpret what's happening when trauma therapy gets difficult.

This episode covers:
• The difference between feeling worse and actually getting worse
• The dust on the mirror effect: what it is, why it happens, and why it's actually a good sign
• Why the worst thing you can do when therapy gets hard is stop
• What the research actually says about clinical deterioration from EMDR

If you've ever had a rough week after a therapy session and wondered whether you should keep going, listen to this.

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Transcript

SPEAKER_00 0:05

Hello, I'm Helen Billows, and this is the Trauma Nerd Podcast. I'm a registered psychologist, EMDR therapist, and I work exclusively with trauma. This podcast is for people who want psychologically sound explanations without topside shortcuts, toxic positivity, or excuses dressed up as empathy. We'll talk about trauma, responsibility, relationships, and recovery, backed by nuance, honesty, and of course, actual evidence. Let's get into it. So have you heard this before? You might feel worse before you feel better. I always thought this line was kind of a tacky way that we prime people to sort of set an expectation that if shit hits the fan at any point and they feel worse, that it's all just part of the process and nothing to panic about, because often it isn't. But after doing exclusive trauma therapy for many years now, I can actually give you the honest take on this. You can absolutely feel worse before you feel better. That is true and totally legit, but there are some important caveats within that statement. Number one being that I'm saying feel worse, not get worse. That is an important distinction. So, hello, I'm Helen Billows, and this is the Trauma Nerd Podcast. I'm a registered psychologist, EMDR therapist, and consultant, and I run a trauma-focused private practice in Adelaide, South Australia. So today I'm touching on what actually what is actually happening when trauma therapy gets challenging. And in my opinion, there are two primary reasons people feel worse after starting trauma therapy. Also, note not everybody does feel worse after starting trauma therapy, but the people that do, these are the two main reasons why. And I think hard experiences are much easier to tolerate when we have an understanding of what's occurring. We can generally cope much better, we expect it, and we have a sense of control about the situation. So I hope that having this knowledge will help you view challenge in trauma therapy and specifically EMDR as a green flag, not necessarily a red one. So the first point to touch on here is that when you come to trauma therapy, what we're doing is bringing up the thing that you don't want to think about, probably. We are intentionally activating it, bringing it in the room, talking about it, looking at it, and working with it. Now, put that into context with the fact that your brain's very natural and automatic, pretty much automatic response to trauma is to avoid it. Whether that's suppressing, burying, uh minimizing, maybe telling yourself it wasn't that bad when it actually was, and yes, that is a form of avoidance. Um your brain has avoided this as a coping strategy because you have to keep living your life, right? Like you have to function with this thing in your brain. So your brain's way of dealing with that is shove it aside, put it away. So your brain's been very intentionally keeping this out of your conscious awareness, and then you come into therapy and very intentionally bring it in to conscious awareness. When we compare avoiding as opposed to working with, of course that feels worse in the moment, anyways, right? So avoiding it, you're not feeling it, as well, you probably are in different ways, but not so sort of directly. You might have been avoiding it for years, maybe even decades, and now we're in the room with it and we're bringing it up and talking about it. So obviously that feels worse than avoiding it. But here is the question: did it actually get worse? No. You felt worse because you actually felt it. Um, maybe that's the first time ever, or maybe it's just the first time in a long time, but you have stopped avoiding and you've started feeling. That's not a deterioration, that's just feeling what was already there. And I think that's an important point too, that whatever you're making contact with, um, that's been sitting there the whole time. Probably longer than you realize. Um trauma therapy is not creating that or generating that. It's just surfacing what's there. We're not creating a problem, we're just bringing it up and engaging with it. Um, so we do that in a very intentional and purposeful way. That um, and we try to keep you as comfortable as possible, but no, it doesn't, it's not going to feel good because that's the whole point. It doesn't feel good, which is why we're working with it. Um, but I guess this is where we really emphasize that idea of short-term pain for long-term gain, a short-term challenge for the with the awareness that this is going to benefit me in the long term. I don't go to the dentist super excited, like, yay, I'm getting a root canal. I go to the dentist like, man, this is gonna suck and it's really important for my health, so I'm gonna just do it. Okay. Trauma therapy, good analogy. Getting a tooth drilled. So the second reason is what I call the dust on the mirror effect. Now, this is a Buddhist analogy I have shamelessly repurposed for clinical purposes. Um, so thank you to whoever came up with it originally. Um, so here is the idea. Imagine you are grabbing a dusty mirror from your brain. The dusty mirror being or the dust on the mirror being the trauma or the pain, whatever, the painful experience, whatever we're working with. And in order to, and like when we engage with it, when we start working with it, we're making an attempt to clear it, to resolve it. And so in this analogy, we're grabbing that dusty mirror, and what's the what do we do to try to clear a dusty mirror? We go, we try to blow the dust off. And what is the first thing that will happen when you blow try to blow the dust off? A dusty mirror, the dust is going to hit you in the face. So, in this analogy, the dust is the painful realizations and emotions that come from unraveling experiences of abuse, neglect, and mistreatment. It's the pain that arises when you see the truth clearly and sometimes for the very first time. So, let me give you a kind of concrete example uh from what I see in my therapy room. So, say growing up, your feelings were consistently dismissed, ignored, or maybe even mocked, made fun of. Um, maybe you got told you were too much, too sensitive, that you made mountains out of molehills. So you adapted to that environment to try to protect yourself. You stopped letting it out, you stopped being authentic, you learned to keep a stiff upper lip, uh, to not reveal your true feelings and to pretend to be okay when you weren't. Over time, that is going to establish some core beliefs. Things like, I'm too much, there's something wrong with me, my feelings are not important. And then you do a few sessions of EMDR and something shifts. And this isn't an intellectual light bulb moment, it's not just a thought that you have in your head, though I mean that'll probably accompany it, but what it will be is a deep felt internal recognition of truth. Some it's gonna probably sound something like my feelings were always normal. The only abnormal thing in that situation was how my feelings were responded to. And if there was something wrong with anybody, it was the people who told me these things. There's nothing wrong with me, and there never has been. When you have lived your whole life believing the opposite of that, the trauma version of that, hello dust. And what is the dust composed of? Probably grief for the child who believed that false version, and grief for the adult who's held onto painful beliefs about themselves that should have never been there in the first place. Also, a really common one is anger. Anger towards the people whose behavior led you to believe things that were never true about yourself and were never yours to carry. So that is obviously not a pleasant experience, but it is a necessary step on the path to resolution because we hit that dust moment and we do keep going. That's not the end point, that's probably like a halfway point, actually. Um, but we keep going, keep going, keep going, and you know what's on the other side of that dust? The mirror. And what the mirror is composed of is truth, clarity, and the version of you that knows on a deep felt level that your feelings are normal, that you are normal, that there is nothing wrong with you, that you are okay as you are, and that in fact you're good. So that is not getting worse. It might feel much worse temporarily, but I would rather emphatically argue that that is getting much better. That is probably, I think, one of the most significant um moments of progress a person can experience in therapy, and in fact, it's very exciting, though painful. So this, these kinds of experiences, so we've got these two sides, the dust in the mirror and the avoidance. In my experience, the beginning of these is when people sometimes start to get a bit freaked out and they're at risk of bailing or ghosting their therapist, aka me. So um the thing about that is the worst thing that you can do when things when you're hitting these experiences is to stop. So A, because if you keep going, it's gonna get so much better. And B because what's if you're driving at night through a dark, scary tunnel, what's the worst thing you could possibly do? Stop. I don't want to stop in the tunnel. In fact, I'm probably gonna accelerate to get through it, to get out of the tunnel. So that's the advice, right? We keep going. We don't stop when it gets challenging, particularly when there are indicators that these circumstances are what is actually occurring. Because these are actually these are indicators of progress. We want to keep going, we want to even accelerate a bit. Okay. So my biggest advice is if you are considering, if you're getting a bit antsy about what's happening in therapy or EMDR, please talk to your therapist about it before you discontinue. Um, not to say that nobody's forcing you to continue, but you don't want to react to something challenging, you don't want to be impulsive about it, and you don't want to react, you want to respond thoughtfully, and your therapist can probably help you make that decision in a way that's in your best interests. So if you are sitting with some anxiety about, you know, wondering whether trauma therapy or EMDR might make things worse, um, that is something I'm going to dedicate a whole episode to because I think there's actually a bit to talk about on this, but I'll give you the too long didn't read version because the opinion uh because the research on this, in my opinion, is very reassuring. I think more assuring than many clinicians are aware of. So fairly recent studies with over 1700 participants show that legitimate, genuine clinical deterioration from trauma therapy is exceptionally rare. And in some cases, fascinatingly, the people who didn't receive treatment deteriorated more than those who did. Um, meaning that the people who were waiting for the treatment did worse than the people who did EMDR. So actually, the research positions EMDR as a really safe therapy. There is, it's very low risk to actually cause a problem or make you worse. I think the biggest risk is just staying the same, probably. That's the more common thing I would, I would say, um, that you don't improve, but you're no worse off, right? So coming back to this idea of feeling worse before you feel better, remember that your body has been carrying whatever you're working with for a long time. And like I said, probably longer than you realize, because it's probably roots of it, um, depending on what you're working with, that go further back than you are aware of. Um, and the fact that things are moving, even if it's challenging and even if it's making you really want to cancel your next therapy appointment, um, that is not necessarily a problem. And sometimes it means you're healing. So thank you so much for listening. If this resonated, share it with somebody. Um, subscribe to the podcast, comment, review, everything helps. And as always, send me your questions to uh the website through the inquiry form at uh www.helenbillows.com. Take care and I'll see you next time. That's it for today's episode of the Trauma Nerd Podcast. If you felt validated, yay! If you felt challenged, double yay. If you found this useful, you can follow or subscribe wherever you listen to podcasts. If you're interested in trauma focused therapy or resources, you can find more information at my website. Thanks for listening and bye for now.