How Much Should Therapy "Hurt"?

[Banned]

I think I've always had the notion that in order for therapy to be effective, or working, it needs to be a painstaking, grueling process - ya know - "no pain no gain".

But, I'm wondering if that actually holds true. I mean, I would think that in order to grow and move forward, one has to step somewhat out of their comfort zone, which can be difficult.

But is it possible that with therapy no pain can actually still mean gain? Should every session be gut-wrenching and difficult, or is it possible to have not-so-difficult discussions and still be making significant progress?

 

[Daniel E.]

The difficult part for me was not the sessions really but the take-home stuff. For example, when I first saw a therapist for shyness, talking to the therapist was easy and mostly pleasant. The hard part was behavior therapy homework assignments like trying to start conversations with strangers, etc.

 

[Banned]

I've never had therapy homework until about a month ago, so I don't know how that will play out for me. I had a hard time getting started on some of the stuff he had/has me doing, but once I got going it was fine. My therapy experiences in the past have always been about showing up for an hour each week and talking, and that's it til the next week. And if there was nothing to talk about, well we just chatted about anything to pass the hour.

I'm finding my new therapist is (thankfully) very different from that, and very good at keeping me focused on what I'm supposed to be working on. As a result, I sometimes find myself a bit more nervous (for lack of a better word) when it comes to intense stuff. I suppose a part of that is normal...and it'll likely pass in time. But I also like the feeling (in a weird kind of way) because that's when I feel like I'm being pushed which, to me, is essential to move forward. But, I might be wrong on that...maybe it doesn't need to be uncomfortable and difficult to be effective. I have no idea...

 

[David Baxter PhD]

You're right in that therapy does involve stepping out of your regular habits and routines and out of your comfort zone, and it does involve challenging your outdated or counterproductive coping strategies. Sometimes, that may involve a certain amount of distress, especially when it comes to facing old trauma and memories or past behavior.

But I don't believe that progress in therapy necessarily is or should be a "no pain, no gain" process. For example, in my opinion, some of the common approaches to anxiety disorders, while they may work, are unnecessarily painful for the patient (e.g., flooding). In my opinion, using panic disorder as an example, strategies which involve minimizing anxiety and providing control over anxiety are far more effective and durable and distress the patient far less.

So I guess I'm saying that to some extent it depends on the therapist and the problems being addressed.

 

[Daniel E.]

For example, in my opinion, some of the common approaches to anxiety disorders, while they may work, are unnecessarily painful for the patient (e.g., flooding).

On that note:

Some therapists might even view worsening during treatment as a sign of progress — a misguided “no pain, no gain” view of psychotherapy...

Ask yourself not just whether you are getting better, but whether you are getting optimal treatment.

To Reap Psychotherapy’s Benefits, Get a Good Fit

Regarding another anxiety disorder, OCD:

The Refocus step is where the real work is done. In the beginning, you may think of it as the "no pain, no gain" step. Mental exercise is like a physical workout. In Refocusing, you have work to do: You must shift the gears yourself....To help you manage this task, we have developed the fifteen-minute rule.

http://forum.psychlinks.ca/obsessiv...our-steps-dr-jeffrey-schwartz-brain-lock.html

 

[Fiver]

I'd say that 20% of my sessions leave me feeling shaken and vulnerable, and the rest usually have offered some kind of understanding of whatever was bouncing in my head at that particular moment. Like Daniel, I do most of my work and have my epiphanies during the week, and I use my therapist to get feedback or to fully flesh the ideas that have been trying to take seed in my brain. Sometimes I need to say it out loud to her so *I* can hear it, and so she can better steer me toward whatever new concept I'm beginning to grip.

So for me, yeah, sometimes it's painful when specific issues are discussed and I can't get out of it. But for the most part I leave feeling like I've resolved some things and have new things to think about until the next time.

---------- Post added at 07:37 PM ---------- Previous post was at 04:34 PM ----------

...upon further thought, if the majority of my sessions left me feeling like I'd been shoved through a meat grinder, I'd be disinclined to continue therapy. However, I must admit that this type of traumatic session usually happens when I broach an area that is extremely painful and then immediately pull back. When I do that it's because I need to get it out but don't want to face it, which is Pat's cue to push me so it can happen in a safe environment. But even then I'm drained for the rest of the day.

And now that I'm thinking even more about it, those subjects become just a little bit easier to talk about the next time they need to air. I'm fortunate to have a therapist whose experience and intuition guide her in keeping a good balance.

 

[Banned]

However, I must admit that this type of traumatic session usually happens when I broach an area that is extremely painful and then immediately pull back. When I do that it's because I need to get it out but don't want to face it, which is Pat's cue to push me so it can happen in a safe environment.

Yes! This is the exact wording I've been looking for...sometimes I'll do the same, and that's my message to my therapist - I need to get it out, but don't want to face it, but I need to face it - please help it happen safely.

Thanks for giving me the words I've been looking for high and low, near and far...that's them.

 

[Fiver]

Oh well hey, you're welcome. But it's not like I'd have given it thought if you hadn't brought it up to begin with.

Now I'm wondering if this is something I do subconsciously knowing that I'm giving her the cue and the permission to push. I mean, I know damn well that if I bring something up and brush it aside quickly, she's going to pursue it if I won't. I think if I didn't trust that she knows what she's doing, my subconscious would be more careful to keep things battened. A therapist who didn't know when to push when I close up would be useless to me.

Conversely, there have been times that Pat has put the brakes on when things were heading toward a point of being too overwhelming for any useful purpose (like, so overwhelming that my mind stops being able to process any of it.)

I'm realizing how important it is to have a good match with the right therapist, and how imperative two-way trust is in a healthy therapeutic relationship.

 

[Banned]

Yup, I think you said that right, Fiver. The right therapist can make the difference between alot of "hurt" and less "hurt" in approaching the difficult topics.

I haven't gotten into a tonne of stuff with my new therapist, but with my last one, if I brought something up but then pushed it aside, she'd leave it. I'm hoping my new one won't do that. (Here's the burning million dollar question --> how long do I keep referring to him as the "new" one?!)

A therapist who didn't know when to push when I close up would be useless to me.

I totally agree. We're not at that point yet (I'm still developing skills to use so that when he starts pushing, I don't collapse) but I've given him permission to push and kick my *ss as much as needed. He's got really good perception for balance too, and not letting me get too far ahead too fast. My instinct is always to run...so I need help "staying" and feeling safe. And I think that whole business of feeling safe helps with the hurting.

 

[Eye Stigmata]

Sounds like this is mostly resolved but I'm throwing my two cents in anyways.

Sometimes I think it's good to have a session with "no pain". Sometimes in the process of dealing with a difficult issue, we feel hurt and pain because it's bothering us so much and it's so painful. Once we've dealt with the issue...and I mean REALLY dealt with the issue, then any further conversation about it / surrounding it becomes easier and not as painful because we've just healed that much more of ourselves. And THAT's the true progress.

 

[Into The Light]

i think part of good therapy also involves sessions that are healing. you come away from those sessions feeling heard, understood, cared for, that your pain matters, and that you're going to get through it all. i have had many sessions that were very healing. not all sessions need to hurt.

 

[David Baxter PhD]

Yes. Exactly.

 

[NicNak]

After my session with my psychiatrist I almost feel like I got a booster shot :teehee:

 

[Ryan Howes]

I really enjoy this question and all the comments. You guys speak from a lot of wisdom and experience.

For me, a few thoughts come to mind:

- I often compare therapy to a personal training (workout coach) relationship: therapists are there to guide and encourage, but the sweat, pain and benefits are the client's. Yes, there is pain, but it's the productive pain you feel when accomplishing a difficult task like finishing a race, not the frustrating/pointless pain of hitting your thumb with a hammer. This pain is part of a journey (away from grief & toward freedom, for example), and that feels worthwhile.

- Most of the pain I see comes when people fight against their defenses. For example, they know they need to feel their sadness, but drift into small talk and have to fight to get into their feelings. It's a grueling battle, but it does get easier as experiencing emotion becomes less frightening.

- Not all therapy needs to be about pushing into pain. There should be time for compassion, celebration and education. Compassion for the injuries that weren't sufficiently understood and grieved. Celebration for all the hard work devoted to healing and each mini-milestone accomplished (we shrinks don't spend enough time on this). And education, chunks of time where we therapists share what we know about the understanding and treatment of the problem. These three tools don't hurt, they empower. I think they're essential for good therapy.

 

[Jazzey]

I really enjoy this question and all the comments. You guys speak from a lot of wisdom and experience.

For me, a few thoughts come to mind:

- I often compare therapy to a personal training (workout coach) relationship: therapists are there to guide and encourage, but the sweat, pain and benefits are the client's. Yes, there is pain, but it's the productive pain you feel when accomplishing a difficult task like finishing a race, not the frustrating/pointless pain of hitting your thumb with a hammer. This pain is part of a journey (away from grief & toward freedom, for example), and that feels worthwhile.

- Most of the pain I see comes when people fight against their defenses. For example, they know they need to feel their sadness, but drift into small talk and have to fight to get into their feelings. It's a grueling battle, but it does get easier as experiencing emotion becomes less frightening.

- Not all therapy needs to be about pushing into pain. There should be time for compassion, celebration and education. Compassion for the injuries that weren't sufficiently understood and grieved. Celebration for all the hard work devoted to healing and each mini-milestone accomplished (we shrinks don't spend enough time on this). And education, chunks of time where we therapists share what we know about the understanding and treatment of the problem. These three tools don't hurt, they empower. I think they're essential for good therapy.

Hmmm, Thank you Dr. Howes. It's interesting to see your perspective on it (as well as others who've expressed themselves on this thread).

As someone who's still fairly new to therapy, I have to admit to some hard struggles though. I feel a lot of pain but I don't want my therapist to feel any of it. So I 'soften' it up for her benefit. I inject a lot of bravado so that she never has to know just how much pain I feel - mostly because I'm still reluctant to show her that side of me (after about 6 months of therapy). Or, I feign a lack of memory about certain events. Whilst I know that this isn't fruitful to the therapeutic relationship, at that particular moment, I just have to look at her and think - "no, can't do that to her today".

Next week, I have to start re-visiting sexual abuse in my childhood. I'm half looking forward to that analysis, and half scared about feeling this need to not show her the true feelings that I feel about all of it...

I know it's ridiculous. But I just wanted to share my perspective. One can have a therapist and appreciate that this is their job, but somehow, I can still look at her and think that she doesn't deserve to take any of this home with her at night. ...

*sigh*....weird thinking, I know....

 

[NicNak]

I feel a lot of pain but I don't want my therapist to feel any of it. So I 'soften' it up for her benefit. I inject a lot of bravado so that she never has to know just how much pain I feel - mostly because I'm still reluctant to show her that side of me (after about 6 months of therapy). Or, I feign a lack of memory about certain events. Whilst I know that this isn't fruitful to the therapeutic relationship,

This snipped part of your post Jazzey I soooo relate to. I tend to throw humor and be nonchalant about things, even now to my Psychiatrist after four years of therapy.

I tend to think he sees right through it though :blush: Infact I know he does, cause he is more aware of what I am doing and saying than I am and all its meaning. I am transparant to him now.

 

[unionmary]

Turtle, Hi!

Perhaps therapy is expanding your "comfort zone"?, so in essence is being quite effective. Because your mind is comfortable with the particular point being discussed in your present point of therapy, you feel no pain, maybe even slight pleasure from making the new accomplishment. Our brains can be so complicated at times.

"You are good when you are one with yourself" Kahlil Gibran
(a wonderful book I was given,,,he is a great philosopher? The Prophet.)

 

[Banned]

Right now I'm really struggling with trying to decide if I "need" therapy or if it's just become a habit over the last five years. Right now it's intensely difficult, and I don't know if that's me wanting to run away from it all or something else. I asked my therapist for a two week break to figure out what I want or need.

 

[forgetmenot]

i too think at times perhaps therapy is not needed but know down deep i am still struggling. I am still feeling the past pains and know without the therapy i would end up in deeper depression or even crisis.
I see small steps happening now trusting to let emotions go a bit.
Without therapy i would not be able to go on with living What i am trying to say don't give up on therapy especially when you are suffering so much your therapist will help you deal with all the saddness. Take care Turtle i hope you start feeling better soon.

 

[Into The Light]

if you're having serious thoughts of suicide, you need therapy, turtle.